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
Fixed Mottling - Staining, blistering on limb (Late stage irreversible sign as the limb is refilled with deoxygenated blood)
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