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76 Cards in this Set
- Front
- Back
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where do blood clots form in the LE
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deep veins (DVT)
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What is a PE?
where does it travel from and to where does it go? |
-PE is a detached thrombus (blood clot) usually from the deep veins in the leg
-it travels to the lung and lodges the main artery of the lungs |
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what are the promoting factors for a blood clot (thrombus)...aka Virchows Triad
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-stasis (or turbulence)
-abnormalities of the vessel wall or damage to the wall -hypercoagulability |
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Alterations in blood flow are part of Virchows triad...what are some examples and causes
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-turbulence
-stasis -mitral stenosis -varicose veins |
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abnormalities of the vessel wall or damage to the vessel wall is part of virchows triad; what can cause these abnormailites
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-shear stress
-HTN |
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what is a white thrombus and a red thrombus
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-white thrombus is made of platelets and occurs in arteries
-red thrombus is made of RBC and occurs in veins |
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where do red thrombi occur
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in veins
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where do white thrombi occur
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in arteries
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Red thrombus can take one of three paths:
1. it can undergo fibrolysin and resolve 2. it can organize to a clot and cause narrowing 3. it can cause a PE ..how long does stabilization take and what is the end result |
-it can stabilize into a thrombus and cause vessel narrowing
--the stabilization can take 7-10 days |
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list some conditions that predispose pts to thrombosis
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-post partum
-ventricular failure -prolonged bedrest -cancer -LE trauma or fracture -deep vein insufficiency -oral contraceptives/estrogen -pelvic or LE surgery |
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what are the symptoms of a DVT and what in office tests can you use
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-pain, heat, swelling
-Homans test -pratts sign |
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what is homans test
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-DF of the foot elicits pain in a DVT
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what is pratts test
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-compression of the calf causes pain
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how does a PE present
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-sudden onset
-triad (dyspnea, chest pain, hemoptysis) -tachycardia is more common then hemoptysis |
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what is a non invasive diagnostic test for DVT
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-Doppler ultrasound
-doppler uses reflected sound waves toshow how blood is flowing |
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what blood test can be used for DVT diagnosis
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-D dimer test
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what is D-dimer
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-d dimer is a fribrin degradation product present in the blood after a clot is degraded by fibrinolysis
-d dimer test can also be used to test for DIC (disseminated intravascular coagulation) |
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what would the following values be in a pt with PE?
-pO2 -chest xary -EKG -V/Q scan |
-O2 <80%
-half of all chest xrays are normal (hemidaphragm, atelectasis, density) -EKG tachycardia -V/Q mismatch with an area of ventilation but no perfusion |
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a V/Q mismatch could signify PE...how is a perfusion scan performed, how is ventilation scan performed?
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-perfusion scan; inject technitium 99 labeled human serum albumin
-ventilation scan: inhalation of xenon 133 |
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list some prophylaxis for DVT
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-compression stockings
-pneumatic compression -early ambulation -aspirin |
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DVT treatment
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-leg elevation
-IV heparin |
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what reverses heparin
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-protmine sulfate (ratio of 1mg protamine to 100 units of heparin)
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what blood test can be used for DVT diagnosis
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-D dimer test
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with heparin treatment, you should monitor PTT daily; you should titrate heparin to maintain a PTT of what
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PTT should be 1.5-2 times the control value
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what is D-dimer
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-d dimer is a fribrin degradation product present in the blood after a clot is degraded by fibrinolysis
-d dimer test can also be used to test for DIC (disseminated intravascular coagulation) |
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how long should a DVT pt remain on Coumadin
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-pt should be treated for 3 months after the 1st incident
-2.5-15 mg/day to keep PT 1.5-2 times the control |
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what would the following values be in a pt with PE?
-pO2 -chest xary -EKG -V/Q scan |
-O2 <80%
-half of all chest xrays are normal (hemidaphragm, atelectasis, density) -EKG tachycardia -V/Q mismatch with an area of ventilation but no perfusion |
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what reverses coumadin
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vitamin K
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a V/Q mismatch could signify PE...how is a perfusion scan performed, how is ventilation scan performed?
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-perfusion scan; inject technitium 99 labeled human serum albumin
-ventilation scan: inhalation of xenon 133 |
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list some prophylaxis for DVT
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-compression stockings
-pneumatic compression -early ambulation -aspirin |
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DVT treatment
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-leg elevation
-IV heparin |
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what reverses heparin
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-protmine sulfate (ratio of 1mg protamine to 100 units of heparin)
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with heparin treatment, you should monitor PTT daily; you should titrate heparin to maintain a PTT of what
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PTT should be 1.5-2 times the control value
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how long should a DVT pt remain on Coumadin
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-pt should be treated for 3 months after the 1st incident
-2.5-15 mg/day to keep PT 1.5-2 times the control |
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what reverses coumadin
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vitamin K
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how long does coumadin take to work (warfarin)
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3-5 days
-so dose 10,000 - 15,000 units of heparin first |
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what is lovenox
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- low molecular weight heparin
-anticoagulant that binds to antithrombin 3 and accelerates activity, while inhibiting thrombin and factor 10a |
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thrombolytic therapy can be used if initiated within 24-48 hours; list some examples
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-urokinase
-streptokinase |
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list 3 DDx for DVT
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-cellulitis
-compartment syndrome -venous stasis |
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superficial thrombophelbitis - explain and treat
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-presents as a palpable cord along the distribution of a vein with erythema, edema and local pain
-treat with local heat, elevation and rest; NSAID can be given |
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Emboli can occur secondary to endocarditis - what is the MC organism
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-strept viridan
-MC in IVDA is staph aureus |
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define arteriosclerosis
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generic term for group of vascular dzs which cause thickening and inelasticity of the arteries thus dec blood supply
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define atherosclerosis
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diminised size of the lumen due to plaque along the intima
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Monckeberg medial calcific sclerosis
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-calcification of the media of the artery
-does not decrease the vessel lumen but does falsely elevate ABI's -does not decrease flow but can decrease pulses due to lack of distensability |
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what are the 6 P's of acute arterial occlusion
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-pain
-pallor -pulselessness -parasthesia -paralysis |
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acute arterial occlusion presents with the 6 P's; how does chronic arterial occlusive disease present
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-intermittent claudication
-rest pain -ischemic ulceration/gangrene |
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why do pts tell you they have calf pain at night
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-because they might have chronic arterial insifficiency and the position of their legs, dependency will give relief
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list the signs of PVD
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-pallor, cyanosis, rubor on dependency
-decreased temp -shiny, scaly skin -thick dystrophic nails -diminised hair -edema |
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list some non invasive vascular tests
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-ABI
-segmental limb pressures |
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where are segmental limb pressures taken and what should the pressure difference be b/w ipsilateral limbs
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-groin, above knee, below knee, ankle and transmet
-there shouldnt be more then 20mm differnce b/w same cuff on ipsilateral limbs |
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List the ABI indices and what symptoms accompany each
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1.0-0.9 (normal)
0.9-0.7 mild (cladication) 0.7-0.5 moderate (rest pain) 0.5-0.3 impendng gangrene 0.3-0.0 distal necrosis |
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TcPO2 (trancut oxygen) ; what number do you need for healing
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-greater then 20-30 mm Hg
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stress testing/treadmill test can be used to test for PVD; explain
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-ambulate on a treadmill uphill for 5 minutes
-then perform ABI; a significant drop in pressures or if the pressure doesnt return to normal soon suggests PVD |
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Tx for PVD
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vasodilators
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define intermittant claudication
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This symptom is defined as a
transient, exercise induced ischemic myalgia, characterized by aching, cramping, tiredness, or tightness of the affected muscle group. - Most often seen in the calf muscles. |
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If a pts arterial blockage progresses from intermttant claudication, what symptom will they then present with
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rest pain (this reflects severe ischemia)
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why does rest pain occur in a pt with severe arterial blockage
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Rest pain is produced by the body's shunting blood from the periphery to a
more central circulation when the person is sleeping. A buildup of metabolites occurs in the muscles, resulting in pain |
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what is ischemic neuropathy and how does it present
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Ischemia due to chronic/acute arterial occlusion will
result in an hypoxic condition of the peripheral nerves. Pain is sharp, shooting, poorly localized, radiating throughout the entire extremity following no distinct nerve root. Pain described as tearing, pulling, or agonizing discomfort. |
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list some systemic causes of leg edema
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CHF, nephritis, nephrosis, hypervolemia, hypoproteinemia,
hypothyroid, hyperadrenalism, lymphedema |
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LE edema can be caused by systemic problems, local problems or drugs; list some local causes
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lymphangiectasis, lymphatic obstruction (filaria, tumors), pelvic
or abdominal masses, varicose veins, venous stasis, thrombophlebitis, popliteal vein obstruction |
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List some drugs that can cause LE edema
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corticosteroids,
estrogen, progesterone; androgens -MAO inhibitors (antidepressent) -hydralazine(vasodilator/nitrate) -methyldopa (alpha agonist for antiHTN) |
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what causes telangiectasias
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visible dilations of capillaries which that result from
arterial or venous insufficiency |
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what are some risk factors for arteriosclerosis
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chronic cigarette smoking, hypertension, diabetes mellitus,
hypercholesterolemia, hyperlipidemia, obesity, stress, lack of exercise, age, and genetics. |
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pedal gangrene is a symptom, not a diagnosis: what is it caused by and what are the two forms
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-caused by impairment in circulation (drugs, trauma, emboli, infection etc)
-wet and dry |
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What is Quinkes pulse and what is the etiology
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-alternate blanching and flushing of the nail bed due to pulsation arteriolar and venous plexuses;
-seen in aortic insufficiency |
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what are the 3 pedal arteries and which is the most imp for perfusing the plantar intrinsics
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-DP, PT, perforating peroneal (takes the place of the DP in the 10% of people that dont have it)
-PT supplys the plantar intrinsics |
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what pedal arteries supplies the dorsum of the foot
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DP
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how much of a pressure difference between segmental limb pressure cuffs could signify an obstruction
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30 mmHg
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what should the pressure be in a normal digit
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70-110 mmHg
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Beta blockers, Ca channel blockers and ACE inhibitors an all be used to treat HTN; which should be used in DM pts and why
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-beta blockers are contraindicated in DM because of the unopposed alpha action
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what is Milroys disease
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Congenital/hereditary form of lymphedema, with the edema
noted at birth to be firm but pitting, chronic, permanent, and confined to the lower extremity. |
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livedo reticularis
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A condition involving the arterioles of the skin
presenting with livid discoloration in a reticular pattern (mottled or lacelike red-blue discoloration) |
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what is acrocyanosis and how does it differ from Raynauds
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-persistent uniform cyanosis of
the feet and toes and associated plantar hyperhidrosis. -Unlike Raynaud's, the vesospesticity extends proximally beyond the digits |
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list the three types of Raynauds vasospasticity and define each
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-Phenomenon: is the clinical presentation of the discoloration
sequence of pallor, cyanosis, end rubor accompanied by paresthesias -Syndrome; symptoms of Phenomenom, but bilateral and recurring; also assoc with underlying CT or autoimmune dz -Disease; consistent recurrence that hasnt been identified to co-exist with any other disorder |
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tx for Raynauds
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The traditional vasodilators, isoxsuprine, pepavarine, niacin
are used in Raynaud's cases. Nitroglycerine 2% ointment applied in a 0.75 inch strip on the dorsum of the foot Q 5 hours has been beneficial when oral vasodilators have failed. Calcium channel blockers (nifedipine end diltiezem) have recently been studied for these disorders. |
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Tx for venous stasis ulcer
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Treatment for venous stasis ulceration is almost always conservative, 'with
compression therapy with graduated elastic compression stockings (30-40 mm Hg), Unna Boot with DuoDERM hydroactive dressings etc., or the "Oregon Protocol |
