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Vascular

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Mind Map on Vascular, created by jeremywee90 on 21/06/2014.
jeremywee90
Mind Map by jeremywee90, updated more than 1 year ago
jeremywee90
Created by jeremywee90 almost 10 years ago
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Resource summary

Vascular
  1. Acute Arterial occlusion
    1. restoration of blood flow w/i 4-6 hrs
      1. heparin 80units/kg bolus
        1. 18u/kg/hr infusion
          1. ptt 60-80
            1. embolus/ acute ischemia
              1. embolectomy
                1. LA
                  1. GA
                  2. lack of claudication
                    1. presence of contralat pulse
                      1. cardiac
                        1. arrhtymias
                          1. anticoag
                          2. aneuryms
                            1. anticoag
                            2. valves
                              1. bacteria endocarditis
                                1. atrial myxoma
                                2. art-art
                                  1. ulcerated atheroma
                                    1. disruption by caths
                                      1. blue toe syndrome
                                        1. pulse + painful lesions in distal extremity
                                      2. aneurysms
                                      3. venous-art
                                        1. intra-cardiac shunts (PFO)
                                          1. intra-pulmonary AVMs (osler-weber-rendu)
                                        2. fresh thrmbus
                                          1. thrombolysis
                                            1. f/u angio
                                              1. stenosis
                                                1. angioplasty
                                                  1. 2DE
                                              2. HD/ICU monitoring
                                                1. thrombin time
                                                  1. fibrinogen lvl, keep >100 mg/dl
                                                    1. fdp lvl
                                                      1. ptt, keep <3-5 x normal limit
                                                        1. fbc
                                                        2. alteplase
                                                          1. urokinase
                                                            1. reteplase
                                                            2. mechanical thrombectomy
                                                              1. w or w/o tpa
                                                                1. 2DE
                                                            3. ECG,CXR
                                                              1. cardiac pt
                                                                1. if unrel to trauma
                                                            4. reperfusion injury
                                                              1. rhabdomyolysis
                                                                1. muscle mass
                                                                  1. duration of ischemia
                                                                    1. aggressive hydration
                                                                      1. diuresis w mannitol 25g IV
                                                                        1. IV infusion of bicarb
                                                                          1. K, lactic acid, CK
                                                                            1. arrthymias
                                                                            2. myoglobin
                                                                              1. pigment nephropathy and ARF
                                                                            3. compartment syndrome
                                                                              1. intracompartment syndrome >30mhg
                                                                                1. fasciotomy
                                                                                  1. > 6 hrs ll ischemia
                                                                                    1. combined arterial/venous injruy
                                                                                  2. level of occlusion
                                                                                    1. 6 'p's : pain, pallor, parasthesia, paralysis, pulselessness, poikilothermia
                                                                                    2. trauma
                                                                                      1. intimal flap
                                                                                        1. arterial wall hematoma
                                                                                          1. compartment sydnrome
                                                                                            1. #/disloc
                                                                                              1. hard signs
                                                                                                1. surgical intervention
                                                                                                  1. operative expxloration
                                                                                                    1. reduction of disloc
                                                                                                      1. prox & distal control of injured artery
                                                                                                        1. end to end anastomosis
                                                                                                        2. completion angio
                                                                                                          1. preparation of uninjured leg or potential vein harvest site
                                                                                                        3. diminished/absent pulses distal to injury
                                                                                                          1. ischemia distal to injury
                                                                                                            1. visible arterial bleeding from wound
                                                                                                              1. bruit at/or distal to site of injury
                                                                                                                1. large,expanding or pulsatile hematoma
                                                                                                                2. soft signs
                                                                                                                  1. doppler comparision w contralat limb
                                                                                                                    1. >10-20% difference
                                                                                                                      1. arteriography
                                                                                                                        1. exploration
                                                                                                                  2. others
                                                                                                                    1. arterial thrombosis
                                                                                                                      1. aortic dissection
                                                                                                                        1. venous outflow occlusion
                                                                                                                          1. low-flow state
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