Limb Ischaemia Flashcards
acute limb ischaemia, PAD etc. (18 cards)
What is acute limb ischaemia?
severe, symptomatic hypoperfusion of a limb, typically presenting with a hx of under 2 weeks
What are the 6 P’s of acute limb ischaemia?
pulselessness
pain
pallor
paralysis
paraesthesia
poikilothermia - ‘perishingly cold’
List some risk factors for developing acute limb ischaemia
age >60
smoking
diabetes
cardiovascular diseases
obesity
hypertension
hypercholesterolaemia
What is the most common cause of acute limb ischaemia?
thrombosis - often from the rupture of atherosclerotic plaques
What classification system is used to grade acute limb ischaemia?
Rutherford classification
What is class 1 acute limb ischaemia?
no sensory or motor impairment
What is class 2A acute limb ischaemia?
minimal sensory impairment with NO motor impairment
What is class 2B acute limb ischaemia?
minimal sensory impairment (with possible rest pain) and mild to moderate motor impairment
What is class 3 acute limb ischaemia?
insensate limb with severe/rigorous motor impairment
If a patient with acute limb ischaemia also has symptoms of PAD, what is the most likely cause?
most likely thrombosis-related, NOT embolism-related
If a patient with acute limb ischaemia has completely normal findings on the other leg, what is the most likely cause?
most likely embolism-related, NOT thrombosis-related
List some differentials for acute limb ischaemia
critical limb ischaemia
compartment syndrome
DVT
Raynaud’s phenomenon
What is critical limb ischaemia?
limb ischaemia that has been occurring for more than 2 weeks
there will be ulcers and signs of gangrene
What initial investigations should be carried out for acute limb ischaemia?
doppler USS to calculate ABPI
ECG to screen for AF
bloods: FBC, U+E, CK, group and save, clotting profile
What does an ABPI under 0.7 indicate?
poor prognosis of acute limb ischaemia
What is the initial management of acute limb ischaemia?
pt kept nil by mouth to prepare for possible surgery
IV heparin
oxygen
analgesia
fluids
List the management options for acute limb ischaemia
thrombolysis drugs
mechanical thrombectomy
endarterectomy
amputation if limb is non-viable or if other managements have failed
How can acute limb ischaemia lead to hyperkalaemia and acidosis?
ischaemia causes tissue death
when perfusion is restored, potassium and hydrogen ions can be released
