Acute Lower Limb Ischaemia Flashcards Preview

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Flashcards in Acute Lower Limb Ischaemia Deck (6):

What is acute limb ischaemia?

Limited blood supply to a limb to the point that it causes ischaemia


What are the causes of acute limb ischaemia?

Common - Peripheral Vascular disease, Embolism, Trauma, Compartment syndrome


What will you ask about/find on history taking of acute limb ischaemia?

Symptoms: 6 P's
Paraesthesia - Tingling
Perishingly cold
Fixed Mottling - Staining, blistering on limb (Late stage irreversible sign as the limb is refilled with deoxygenated blood) 

Risk Factors:
Cardiovascular Risk Factors
Peripheral vascular disease

Specific questions to ask in a history taking:
Speed of onset - Acute indicates embolism whereas chronic onset in previously diseased limb indicates thrombosis
Ask about sources of possible emboli – AF, Cancer, MI, Aneurism (aorta, femoral, or popliteal)
Time since it started - May affect treatment

Compartment Syndrome – History of trauma, Pain worsened by passive movement
DVT – Swollen tender limb, that is normally red/inflamed
Neurological Infarct causing paralysis – Other neurological signs or more than one limb affected


What will you find on examination of a a patient with acute limb ischamiea?

Feel pulse to assess for any arrhythmias that may predispose to clots (e.g. AF)
Assess for any underlying cardiovascular risk factors or pathology that may predispose to an embolus
Look for the 6 P’s
Do full neurological examination of the affected limb – Loss of sensation is common, but loss of motor function is a later sign
Ascertain up to which point the pulse is palpable - Femoral  Popliteal  Posterior Tibial  Dorsalis Pedis


What investigations will you order acute limb ischamiea?

ECG – Looking for any arrhythmia e.g. AF that may predispose to embolism formation if no underlying cause identified
Capillary Glucose – Assessing cardiovascular risk factors

FBC – Anaemia can precipitate any ischaemia
ESR/CRP – Will be raised in arteritis
Lipids – Assessing cardiovascular risk factors
Thrombophilia screen If no underlying cause identified
Pre-operative bloods – U&E, Group and save, Clotting

Urgent Arteriography – To confirm diagnosis if in doubt
Echo - Looking for any underlying defect that may predispose to embolism formation in no underlying cause identified
Aortic/Popliteal/Femoral Ultrasound – Looking for an aneurism that may predispose to embolism formation in no underlying cause identified


What is the treatment of acute limb ischamiea?

High Flow O2
Heparin as soon as possible – Improves limb salvage rate
Morphine wih Metoclopramide – For the pain

Trauma– Reconstructive surgery
Acute Embolism – Intra-arterial thrombolysis (Urokinase) or Surgical embolectomy with fogarty catheter when that will take too long
Chronic Thrombosis – Angioplasty/Bypass surgery or Intra-arterial thrombolysis (urokinase),
In an Unviable Limb (Nerve damage, tissue death) - Amputation
After all surgery give post op heparin and treat the underlying cause