Exam 2 CARDIOTHORACIC/VASCULAR EMERGENCIES Flashcards Preview

Q4 EM Surg > Exam 2 CARDIOTHORACIC/VASCULAR EMERGENCIES > Flashcards

Flashcards in Exam 2 CARDIOTHORACIC/VASCULAR EMERGENCIES Deck (54):
1

Aneurysm is?

Abn vessel dilation

2

Dissection is?

Tear in intima of vessel wall
Blood into media -> splits creating false channel

3

Artherosclerotic Aneurysm U located?

Preceding sxs?

U a/w?

abdominally

U none before rupture

Comorbidities: CAD, PVD, COPD, DM, Renal fail

4

AAA diagnostics? (2)

US for dx and follow (always do US for abd complaint)

CT/MRI for plan

5

AAA intervention determination?

< 5.5, not enlarging, asympt =
US Q 6-12 mo

> 5.5, rapid expansion or sympt =
intervention

6

AAA presentation? (6)

Abd pain
P Flank/Back pain
Pulsatile abd mass
Tender
HypoTN
Hemodynamic instability

7

Ruptured or Sympt AAA management?

ABCs
2 large bore IVs
Type/Cross 10u PRBC
Pain mgmt
BP @ 80-100
US
To OR

8

TRIAD of Aortic Dissection- CONSTELLATION

1. Abrupt onset of thoracic or abdominal PAIN w/a sharp, tearing quality
2. mediastinal &/or aortic WIDENING on chest radiograph
3. HTN +/- discrepant BP or pulse (absence of a proximal extremity)

9

Aortic Dissection (AD) U located?

Risk factors? (4)

thoracic

age
HTN
CT dz
Preggos

10

AD presentation? (7)

EMERGENCY
Chest pain
Back pain b/w shoulder blades
Neuro ∆s
Distal ischemia (limb, gut, kidney)
Acute cardiac failure (aortic regurg, ischemia)
HypoTN
Shock w/ rupture

11

AD preceding signs/sxs? (6)

HTN
Discrepant BP b/w extremities
Widen mediastinum
Pleural capping
Pleural effusion
Hoarseness

12

AD Type A?

In ascending aorta
Most C
Emergent surgery for all
High mortality

13

AD Type A complications?

Aortic rupture
Tamponade
Acute aortic regurg
Acute coronary ischemia

14

AD Type B Uncomplicated?

Not involving ascending aorta
No rupture or ischemia
Surgical or endovascular tx

15

AD Type B Complicated or Failed Mgmt sxs?

Persistent pain
Progress to dissection
Marfans

16

AD imaging? (3)

Spiral CT = standard of care
MRI
TEE

17

AD initial mgmt? (3)

1) ↓ SBP < 100
2) ↓ LV dP/dT (contractility)
3) Pain mgmt

w/ β-block then vasodilator (Nipride)

18

Thoracic Aortic Aneurysm invasive tx:

Ascending and/or Arch?

Descending?

asc = Sternotomy w/ surgical repair, P aortic valve

des = Thoractomy w/ surgical repair or endovasc graft

19

Thoracic Aorta injury: Transection caused by?

U from rapid deceleration
???? slide 30

20

Thoracic Aortic injury: Transection diagnosis?

Mishaped mediastinum
Blurred aortic knob
Wide mediastinum
2nd rib fracture
Pleural effusion
Apical capping

CXR then Spiral CT

21

Thoracic Aortic injury: Transection mgmt?

Open or endocardial repair
High risk of paraplegia

22

Blunt cardiac injury: Cardiac Rupture?

U pulmonary hilum

23

Blunt cardiac injury: Myocardial Contusion?

similar sxs to MI (pain, N/V, SOB, arryh)
P Rv or RA infarct or rupture

Serial ECG/telem
Serial enz
ECHO
watch for 48 hrs

24

Traumatic Diaphragmatic Hernia?

U Male and L sided

Resp distress
↓ Breath Sounds
BS in chest
Abd pain
Paradox resp

Tx w/ transabdominal repair

25

Penetrating Chest Trauma signs/sxs? (5)

Hemoptysis
Pneumothor
SQ emphysema (air in skin on chest/neck)
Mediastinal emphysema
Beck's Triad

26

Penetrating Chest Trauma work-up?

Helical CT
Echo
Angiography

27

Penetrating Chest Trauma: Emergent L Thoracotomy when?

Hemodyn unstable
Witnessed arrest despite resuscitation

28

Esoph Rupture/Boerhaave Synd location?

Presentation? (6)

L postlateral distal esoph

Retrosternal/Up abd pain
Tachy
Dyspnea
Fever
Odynophagia
Hamman's Sign (crunching, rasping sound synchronous w/ heart beating against air-filled tissues)

29

Boerhaave Synd diagnostics? (3)

Tx? (4)

CXR = free air in mediastinum
CT
Esophogram w/ gastrograffin

FATAL if not caught (still high mortality)

ABCs
Fluids
ABX
Surgery

30

PeriMyocardial Infarct Emergencies include? (3)

Acute VSD (Ventricular Septal Defect)
Acute Mitral Regurg
Acute Mesenteric Ischemia

31

Acute VSD (C) a/w?

Exam finding? (3)

Transmural Anterolat MI
2-5 days post

Harsh, holosystolic murmur
+/- thrill
↓ hemodynamics

32

Acute VSD study?

Tx?

Echo w/ color flow

Thrombolytics
URGENT SURG REPAIR

33

Acute Mitral Regurg caused by?

Papillary mm rupture in acute MI
U postmedial
~13 hrs post

34

Acute Mitral Regurg exam findings?

Tx?

Acute pulmonary edema
Pansystolic murmur, apex to axilla
↓ afterload

U surgery necessary

35

Acute Mesenteric Ischemia caused by Arterial Embolism?

C 2° to cardiac thromboembolism (Afib)
U location is SMA, IMA least

36

Acute Mesenteric Ischemia caused by Arterial Thrombus?

U from progression of preexist atherosclerosis
C involvement of 2 vessels following dehydration, hypercoag state

37

Acute Mesenteric Ischemia caused by Non-occlusive events: Types of causes?

Severe/Prolonged vasoconstrict
Low CO
α-agonists, digoxin, ergots, cocaine

38

Acute Mesenteric Ischemia exam findings?

If SMA involvement?

Early dx critical (< 12 hrs)

Severe abd pain w/o many abd findings,
N/V/D and ileus (P) + guaiac

TRIAD of SMA embolism:
GI emptying
Abd pain
Underlying cardiac dz

39

Acute Mesenteric Ischemia labs? (3)

CBC = Leukocytosis
D-Dimer = ↑
LDH = ↑

All are non-specific

40

Acute Mesenteric Ischemia management? (6)

ABC
Cardiac monitor
O2
IV access/fluids
Abx
Pain mgmt

41

Acute Mesenteric Ischemia imaging?

Multi-detector CT
Angiography

42

Acute Mesenteric Ischemia tx?

Papaverine Infusion
Embolectomy
Intraarterial Thrombolysis
Bypass or Reimplant

43

Aorto-Iliac Occlusive Dz is?

EMERGENCY
Saddle embolism at bifurcation OR
In-situ thrombosis of already dz'd segment

44

Aorto-Iliac Occlusive Dz presentation?

Neuro deficit including paralysis,
Absent femoral pulses

45

Aorto-Iliac Occlusive Dz tx?

Quick imaging
Surgery

46

Acute Arterial Obstruction is?

EMERGENCY
Sudden stop of blood to extremity

47

Acute Arterial Obstruction cause by? (4)

Embolism U from heart or aorta
Thrombus in situ from trauma or ↓ flow
Hypercoag state
External compression of artery

48

Acute Arterial Obstruction from Embolism U result of? (5)

Afib
LV thrombus
Cardiac myxoma (benign tumor)
Valve dz
Plaque, fat, air

49

Acute Arterial Obstruction from In-situ Thrombus result of? (5)

Catheter
Stent/graft
Popliteal aneur
Hypercoag or low flow states
Arterial dissection

50

6 P's of Acute Obstruction?

Pain
Pallor
Paresthesia
Paralysis
Pokilothermia
Pulselessness

51

Acute Arterial Obstruction tx?

Emergency surg
Heparin
Thrombolytics
Thrombus removal
Embolectomy or Bypass

52

Compartment Syndrome C after what?

6 Ps of Compartment Synd?

Reperfusion of ischemic limb (U) calf

Pain out of proportion
Pain w/ passive stretch
Paresthesia
Paralysis
Pokilothermia
Pulselessness

53

Compartment Syndrome diagnosed how?

Untreated w/i 8hrs P results in?

Clinically
P pressure measurement > 25 mmHg

Permanent nn damage
Limb loss
Death

54

Compartment Syndrome tx?

Fasciotomy