4. Differentiating thrombosis and
embolism
Sudden onset pain Sub acute onset
Young patient Elderly patient
Has a source of emboli* No source of emboli
No history of occlusive
arterial disease
History of occlusive arterial
disease
Other pulses are present Other pulses may be absent
5. Sources of emboli
Heart – recent MI, Atrial fibrillation,Valvular
heart disease.
Blood vessels – aneurysms
An embolus gets stuck at sites of bifurcation
as the diameter of the vessels reduces at
these places.
6. Acute limb Ischaemia
Presentation
“ P ”s
Pain
pallor
Perishing cold
Pulselessness
Paresis / paralysis
Paraesthesia / anaesthesia.
Beware
After trauma
After anaesthesia
Acute limb ischemia is a clinical diagnosis -there is no need of
imaging.
7. Acute limb Ischaemia
Management
Recognize
Start unfractionated heparin
Loading dose 75 – 100 IU/Kg ( approximately 5000 IU )
Followed Infusion of heparin -18U/kg (approximately -
1000U/hr)
Refer to vascular surgeon
Pain relief
Keep fasting
Inform theatre and anaesthetist
Consent – for embolectomy and fasciotomy
Check theViability of the limb - note.
8. Acute limb Ischaemia
Surgery
Embolectomy with fogarty
catheter
Can be done under LA
9. Post operative management
Monitor distal pulse
Keep foot elevated
Monitor movements and sensation
Continue Heparin – 18U/kg per hour infusion
Start warfarin when surgical bleeding is not a
concern
Monitor for reperfusion effects
10. Complications of Acute limb
Ischaemia
Limb loss
Death
Compartment syndrome
Reperfusion effects
Volkmann ischemic contracture
11. Reperfusion effects
Local
Reperfusion injury – paradoxical death of already
dying muscles after reperfusion
Systemic
Reperfusion syndrome
Hypotension
ARDS
Lactic acidosis
Hyperkalemia
Renal failure
25. Compartment syndrome
Clinical features
Excessive pain - pain on passive movements
Numbness -e.g. anterior compt. first toe web (deep peroneal N )
Tense swollen leg
Do not look for absent distal pulse – late