Flashcards in Acute Vascular Emergencies Deck (21)
Loading flashcards...
1
ruptured AAA
aortic diameter >3cm
risk factors include aged >60, smoking, fhx, male.
loss of elastin and smooth muscle in the aortic wall associated with elevated MMP
symptoms: back pain and abdominal pain, flank pain and testicular pain, collapse and LOC, shock- pallor, HP , low BP, sweating.
tender expansile swelling
differentials- MI, stroke, hypoglycaemia
2
investigations for ruptured AAA
(if stable hx and examination)
if unstable
bedside:
vitals (HR, RR, BP)
ECG
oxygen
large bore venflon
hartmanns if hypotension
urinary catheter
urgent CT
inform vascular reg or consultant
bloods:
FBC, U+E, creatinine, glucose, clotting screen
ABG
XM 6-8nuts?
warn blood bank- FFP and platelts
3
AAA scoring systems to operate
Hardman
Glasgow aneurysm score
V POSSUM
APACHE II
*open operative treatment
*endovascular repair (EVAR)
(ask about this on placement)
complications- death, multi organ failure, haemorrhage, embolism, thrombosis, graft infection
4
acute limb ischaemia
acute or acute on chronic
embolic causes: AF, MI, AAA, popliteal aneurysm
thrombotic- atherosclerosis
signs and symptoms:
sudden onset of painful, cold white foot
six p's= pulseless, paralysis, paraesthesia (nerve ischaemia 1-2hrs), pain, pallor, perishingly cold
5
acute limb ischaemia- assesment and investigations
A-E
full history and examination
bloods: fbc, u+e, creatinine, cs, glucose, ABG, group and save, troponin, CK
oxygen
ECG
ABPI*
analgesia
nil by mouth
IV cannula , heparin bolus, infusion, fluids
immediate senior review.
angiogram dependent
6
acute limb ischaemia management
embolectomy and fasciotomy
brachial embolectomy
7
mesenteric ischaemia causes
acute / chronic
if acute- occlusive or non occlusive mechanism leading to hypoperfusion of one or more of the mesenteric vessels and therefore loss of blood supply to the bowel (1/3 of CO goes to the midgut)
mechanism- thrombotic or emboli, hypoperfused state, iatrogenic (angioplasty)
RF- age, smoking, IHD, HT, diabetes, AF, CCF, hypercoagulable state
8
mesenteric ischaemia symptoms
severe or non-severe non localised abdominal pain with little tenderness. possible history of chronic pain with weight loss, peritonitis, sepsis.
HR high and BP low
9
mesenteric ischaemia investigations
full history and exam
plain AXR and erect CXR
bloods- FBC, U+E, creatinine, culture and sensitivity, group and save, ABG, lactate, CK, amylase, LFT
diagnosis can be difficult and delayed
tx: o2, IV fluids, abx, catheter, NGT, IV heparin
AXR shows portal venous gas, pneumatosis, thumbprinting and free air
10
mesenteric ischaemia treatment
supportive
restore flow
resect any nonviable tissue
supportive care
catheter directed thrombolysis
11
vascular trauma
penetrating- stab, gunshot, impaling
blunt- crush, acceleration deceleration, fracture dislocation
A-E
12
aortic dissection pathophysiology
tear in the media of the aortic walldue to micrifbril and elastin degedation in the media. true and false lumen*
risk factors
hypertension
congenitally deformed
connective tissue disorders
pregnancy
13
aortic dissection symptoms and signs
sudden death
severe and sudden chest pain or back pain (ripping/tearing)
hypertension
hypotension
high index of suspicioun
pulse deficit in arms, loss of distal pulses
paralysis
murmur
ischaemia of any organs
14
aortic dissection investigations
ECG
CXR
CT angiogram
bloods- FBC, U+E, LFT, CS, G+E
echo (transoesophageal echo0
15
aortic dissection management
type A stanford (ascending aorta) replace the aortic root
type B (not involving the ascending aorta) medical management to reduce stress on aortic wall (IV vasodilators and beta blockers)
endovascular - acute dissection with branch vessels ischaemic
fenestration and stent
16
venous bleeding
causes: blunt or penetrating trauma, iatrogenic trauma (e.g misplaced central line) complication of anticoagulation (spontaneous/compounding factor)
complications of anticoagulation- spontaenous/compounding factor
abdominal venous pressures
oesophageal varices
venous obsturction
17
normal blood volume for 70kg man
5000ml (5L)
estimated blood volume (ml)= weight (kg) x 75 (ml)
18
classes of shock/haemorrhage
CLASS I
class I
HR <100, BP normal, conscious normal/anxious, UO >30ml/hr
blood loss % vol <15% (750mls)
19
CLASS II
HR 100-120
BP normal
mildly anxious
UO 20-30ml/hr
blood loss % volume 15-30% (750-1500ml)
20
CLASS III
HR >120
BP decreased
confused
urine output 5-15 ml/hr
blood loss % (volume) 1500-2000 ml
21
