Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
65 Cards in this Set
- Front
- Back
|
What is pernio syndrome?
|
slow freeze
aka chilblains |
|
|
What are signs of hypersensitivity to cold?
|
cold urticaria: due to allergy, autoantigen, vasomotor disturbances
|
|
|
acute pernio syndrome
|
-cyanotic dermatitis
-erethematous -edema -intense itching and burning -clears in 7-10 days -may remain hyperpigmented for weeks -due to vasospasm of cold skin -avoid scratching skin -avoid heat when rewarming |
|
|
chronic pernio syndrome
|
-repetitive exposure to cold and humid conditions
-lesions are erythematous and may ulcerate -may reulcerate in cold and heal in warm weather |
|
|
What is a pathological change that occurs with chronic pernio?
|
Angiitis:
-thickened arterial walls, -necrosis of paniculus adiposis, -chronic inflammatory reaction of the subcutaneous tissue |
|
|
Diagnosis of chronic pernio
|
-chronic erythema
-ulcerating skin -burn/itch -red and elevated lesions -bullae may develop -hyperpigmentation |
|
|
Conditions similar to chronic pernio
|
erythema nodosum:
-spring and fall -NEVER ULCERATE -resolve without hyperpigmentation Idiopathic Nodular Vasculitis -more painful -rarely ulcerate |
|
|
Trench foot/immersion foot
|
-change in peripheral circulation due to exposure to cold and dampness
-imflammatory reaction -usually due to exposure to cold water -mild medial fibrosis of small arteries |
|
|
3 phases of trench/immersion foot
|
1. initial vasospastic phase
2. post immersion hyperemia 3. late vasospastic phase |
|
|
initial vasospasm phase of trench/immersion foot
|
-ischemia
-pale, cyanotic, cold -decreased pulses -edema -violaceous ulcers may appear -lesion may be anesthetic |
|
|
post immersion hyperemia
|
-after injury during rewarming
-red and hot -pulses return -bullae may appear with hemorrhagic or serous fluid -burning paresthesia -last 2 weeks -may develop gangrene with possible bleeding around site |
|
|
late vasospastic
|
-further ischemia
-can be prevented -2 weeks to months after injury -feet become hyperhydrotic -extreme sensitivity to cold -gangrene ensues |
|
|
treatment of trench/immersion foot
|
-preserve body heat
-elevate feet and legs -prevent exercise and trauma -vasodilators -amputation |
|
|
frostbite
|
freezing of tissue due to cold
|
|
|
Direct frostbite
|
slow freezing
-extracellular ice crystals -most common rapid freezing -intracellular ice crystals -rare -supercooled liquids or metals |
|
|
indirect frostbite
|
-vasomotor response to cold
-occurs in later stages of frostbite -due to AV shunting |
|
|
4 stages of cold injuries
|
1. prefreeze
2.freeze-thaw 3. vascular stasis 4. ischemic late phase |
|
|
prefreeze stage of frostbite
|
-arteriole vasoconstriction
-venodilation -leaking of intracellular fluids |
|
|
freeze thaw phase of frostbite
|
extracellular ice crystal formation due to ruptured cell membranes
tissue damage is reversible if injury is stopped |
|
|
vascular stasis phase of frostbite
|
AV shunting
distal tissue hypoxia |
|
|
ischemic late phase of frostbite
|
-prolonged hypoxia and neural damage
-nerve and muscle damage -muscles swell and necrose -atrophy of skin -disappearance of hair follicles/sweat glands |
|
|
Classification of frostbite: 2 systems
|
Orr/Fainer: stage 1-4
washburn: superficial/deep |
|
|
Orr/Fainer Frostbite classification system
|
stage 1:
-erythema -edema -no bullae stage 2: -BULLAE stage 3: -FULL THICKNESS INJURY and GANGRENE stage 4: -COMPLETE NECROSIS and loss of part |
|
|
signs of good prognosis for frostbite
|
-clear fluid in bullae
-intact sensation -pink skin when thawed |
|
|
bad prognosis in frostbite
|
-white/cyanotic
-insensate -hemorrhagic blisters -muscle necrosis -gas gangrene |
|
|
risk factors for frostbite
|
-low temperature
-long exposure -moist environment (water conducts 25x faster than air) -wind chill (temp-2xwind) -alcohol: vasodilate, increase heat loss -tight shoes: decrease O2 |
|
|
treatment for hypothermia
|
rewarm slowly: 1 degree C/hour
avoid rewarming shock- intense vasodilation |
|
|
treatment of frozen extremity
|
rapid rewarming with pain meds
100-112F liquid |
|
|
Treatment of frostbite
|
-fluids
-possibly abx -leave hemorrhagic bullae intact -drain clear bullae -NWB -let demarcate -bone scan -amputation |
|
|
5 D's of frostbite
|
-Deroof bullae
-dressing changes -debride -demarcate -definitive amputation |
|
|
What is erythermalgia?
|
painful and erythematous skin without a cause
due to: -myeloproliferative disorder -ideopathic -secondary |
|
|
Primary or ideopathic erythermalgia
|
-no associate disease
-rare -possibly the other disease is not diagnosed |
|
|
secondary erythermalgia
|
erythermalgia associated with other disorder
myeloproliferative disords -polycythemia vera -thrombocytopenia |
|
|
5 criteria for erythermalgia
|
1. burning
2. erethematous 3. pain is intensified with exposure to heat 4. cold relieves pain 5. no response to therapy |
|
|
common traits of erythermalgia
|
-usually seen in summer
-middle age patients |
|
|
treatment of erythermalgia
|
aspirin
NSAIDS |
|
|
tourniquet
|
-arrest cirulation to limb to provide bloodless field
|
|
|
Tourniquet musts
|
-make sure tourniquet is properly padded (webril)
-exanguanate area first |
|
|
ankle joint tourniquets
|
-ABOVE MALLEOLI
-inflate to 100mmHg above systolic BP (approx 250) |
|
|
calf tourniquet
|
-risk of sliding down
-difficult to exanguanate -use if unable to use thigh tourniquet |
|
|
thigh tourniquet
|
-inflate 175mmHg above systolic
-apply as high as possible |
|
|
Tourniquet pressures
|
ankle: 100mmHg over systolic
thich: 175mmHg over systolic |
|
|
pneumatic tourniquets
|
looks like BP cuff, hooked to machine to measure pressure
|
|
|
esmark tourniquet
|
use to exanguate foot
max pressure 250mmHg |
|
|
digital tournicot
|
toe tourniquet
|
|
|
how to exsanguanate
|
use esmark
elevate inflate elevate above heart for 2 minutes or use esmark don't exanguanate if signs of infection |
|
|
maximum time limit for tourniquet use
|
90-120 minutes
perfuse 5 minutes for every 1/2 hour over |
|
|
risks associated with tourniquet use over 2 hours
|
mitochondrial damage
poor healing potential |
|
|
complications of tourniquet use
|
if pressure is not high enough- only venous drainage will be blocked
calcified arteries cannot be blocked- take off tourniquet so venous drainage occurs never use bilateral thigh tourniquets- overload heart increase BP, HR hypercoaguable state- DVT risk post-op incresaes acidosis and increased K+ (when released affects heart) blood vessel damage thrombophelbitis thigh tourniquet: damage to lateral femoral cutaneous nerve (myalgia paresthetica) paralysis |
|
|
contraindications to tourniquet use
|
1. hypercoaguability (hormone therapy, previous DVT
2. obese- unable to occlude artery 3. decreased vascularity 4. thrombophelbitis (don't further irritate veins) 5. sickle cell anemia- can cause crisis |
|
|
vasculitis
|
inflammation of vessels leading to necrosis
|
|
|
polyarteritis nodosa
|
small/medium sized arteries
all layers inflamed nodal aneurysms |
|
|
allergic granulomatosis
|
small arteries and veins
lung involvement eosinophilia |
|
|
hypersensitivity angiitis
|
small arteries/veins
history of drug allergy- sulfa all organs are in the same stage of disease |
|
|
pathogenesis of vasculitis
|
unknown
with hepatitis associated with antitrypsin deficiency infectious malignancy |
|
|
Labs in vasculitis
|
WBC: increased, granulomatosis, eosinophilia
anemia: normochromic, cytic increased ESR increased CRP (c-reactive protein) quantitative Ig increased Ig: systemic necrotizing vasculitis increased IgA: henoch-scholein purpura renal function: proteinuria, hematuria, red cells rheumatoid factor: SLE and sceroderma angiography: saccular or fusiform aneurysms, vessel narrowing TISSUE BIOPSY: HIGHEST DIAGNOSTIC DETERMINANT |
|
|
polyarteritis nodosa
|
only seen on arteriogram
inflammation of small vessels nodular thickening of vessels walls of vessels are infiltrated by PMNs: lymphocytes, eosinophils causes fibrinoid necrosis vessels will eventually thrombose or form aneurysm if arterial flow is stopped, necrosis occurs and lesions develop with gangrene 40-60YO, fever, malaise, may appear toxemic from infection abrupt onset of peripheral neuropathy cutaneous lesions: nodules, palpable purpura, ulcerations hemoptysis wheezing/cough uclerations, neuropathy transient arthritis NECROTIC, FIBROUS ULCERATION, USUALLY NEAR ANKLES, LOOKS LIKE ISCHEMIC AREA |
|
|
Polyarteritis lab findings
|
increased ESR
anemia eosinophilia proteinuria arteriogram: aneurysms, narrowed/tapered vessels EKG: tachycardia Chest x-ray for possible mass |
|
|
polyarteritis nodosum prognosis
|
treat with steroids and immunosuppressives
poor prognosis, but not fatal lasts days to years |
|
|
polyarteritis nodosum diagnosis
|
BIOPSY: SKIN, MUSCLE, NERVE
obscure illness increased ESR eosinophilia |
|
|
allergic granulomatosis
|
CHURG STRAUSS SYNDROME
ADULT ONSET ASTHMA: seen prior to vasculitis, increased IgE extravascular granulma unknown etiology palpable purpura/nodules |
|
|
allergic granulomatosis pathology
|
lung, GI, skin involvment
granulomatosis infiltration of vessels eosinic infiltration of vessels small arteries and veins lumen narrowing usually die due to MI |
|
|
allergic granulomatosis labs
|
EOSINOPHILIA
leukocyte count over 60,000 increased ESR increased IgE anemia |
|
|
Allergic granulomatosis diagnosis
|
HISTORY OF ADULT ONSET ASTHMA
eosinophilia biopsy of VESSEL: EOSINOPHILIC INFILTRATES and necrotizing vasculitis |
|
|
Allergic granulomatosis treatment
|
steroids
immunosuppressants |
