Vascular

Vascular

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

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	Criado por jeremywee90 quase 10 anos atrás