Acute Vascular Emergencies Flashcards

(21 cards)

1
Q

ruptured AAA

A

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

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2
Q

investigations for ruptured AAA

A

(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
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3
Q

AAA scoring systems to operate

A
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

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4
Q

acute limb ischaemia

A

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

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5
Q

acute limb ischaemia- assesment and investigations

A

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

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6
Q

acute limb ischaemia management

A

embolectomy and fasciotomy

brachial embolectomy

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7
Q

mesenteric ischaemia causes

A

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

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8
Q

mesenteric ischaemia symptoms

A

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

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9
Q

mesenteric ischaemia investigations

A

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

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10
Q

mesenteric ischaemia treatment

A
supportive
restore flow
resect any nonviable tissue
supportive care
catheter directed thrombolysis
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11
Q

vascular trauma

A

penetrating- stab, gunshot, impaling

blunt- crush, acceleration deceleration, fracture dislocation

A-E

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12
Q

aortic dissection pathophysiology

A

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
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13
Q

aortic dissection symptoms and signs

A
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
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14
Q

aortic dissection investigations

A
ECG
CXR
CT angiogram
bloods- FBC, U+E, LFT, CS, G+E
echo (transoesophageal echo0
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15
Q

aortic dissection management

A

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

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16
Q

venous bleeding

A

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
Q

normal blood volume for 70kg man

A

5000ml (5L)

estimated blood volume (ml)= weight (kg) x 75 (ml)

18
Q

classes of shock/haemorrhage

CLASS I

A

class I
HR <100, BP normal, conscious normal/anxious, UO >30ml/hr
blood loss % vol <15% (750mls)

19
Q

CLASS II

A
HR 100-120
BP normal
mildly anxious
UO 20-30ml/hr
blood loss % volume 15-30% (750-1500ml)
20
Q

CLASS III

A
HR >120 
BP decreased
confused
urine output 5-15 ml/hr
blood loss % (volume) 1500-2000 ml
21
Q

CLASS IV

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