Acute Vascular Emergencies Flashcards Preview

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Flashcards in Acute Vascular Emergencies Deck (21)
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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

CLASS IV

HR >140
decreased BP
lethargic
UO= anuric
blood loss in % 40% >2000ml