Week 3 Flashcards
(16 cards)
What happened to Joannie? Why did she come into the clinic?
after a swimming exercise, her entire left arm was swollen
hx of slight tingling in the ulnar aspect of her arm
no red lesions or localized tenderness
slightly reduced ROM due to swelling in affected arm
larger arm circumference in affected arm
What is compartment syndrome & how might it relate to this case?
this is the problem of swelling of an extremity in a tight fascial bundle
The pt is bradycardic. Is this concerning?
Normally, yes. Here: no b/c she is a conditioned athlete.
Why might we care that she is currently on an oral contraceptive pill?
b/c this can be thrombogenic b/c of the presence of estrogen. Turns out, doesn’t make a difference in this case. b/c it was in the upper limb & effort-related
What is the significance of there being no localized tenderness on the arm?
probably point away from traumatic tissue injury
also points away from arterial occlusion as that is painful
points towards venous occlusion b/c that is non-painful, & only gives a sensation of “fullness.”
Why didn’t the physician check her for pitting edema in this case?
b/c that is much more likely to be a situation for lower extremity than upper extremity
T/F Temp differences b/w the affected & unaffected arm would be helpful in this case.
True. Can point one way or another in terms of arterial or venous occlusion.
What is thoracic outlet syndrome?
syndrome involving compression @ the superior thoracic outlet that puts excess pressure @ the neurovascular bundle
What are the characteristics of an arterial occlusion?
Pain Reduced sensation in extreme cases Cold limb Pale Not swollen until there is reperfusion Pulseless
What are the characteristics of a venous thrombosis?
Not painful, sense of fullness
Swollen
Warm
Normal pulses
What are the principles you should consider when ordering tests?
- likelihood of diagnosis.
- Risk of diagnosis
- Cost & invasiveness
What was the pt’s diagnosis?
Paget-Schroetter Syndrome
subclavian vein thrombosis
What test would we order to confirm this?
subclavian vein ultrasound
What are the hallmark signs of subclavian vein thrombosis?
Acute Swelling
Blue discoloration→phlegmasia (white) & cerulia (blue)
Visible Collateral often-Doesn’t appear immediately
T/F Any foreign body in a vessel causes inflammation & likely thrombosis eventually.
True.
What are the symptoms of SVC syndrome?
swelling of the head, neck & arms
