1
Q
Risk factors for PVD
A
Diabetes smoking HBP Obesity hyperlipidemia clotting factors family history lack of activity over 65
2
Q
common sources of eboli
A
chronic ulcerative colitis
IV drug use
aortic thrombi that embolize
thrombi within the heart that embolize
3
Q
signs and symptoms of emboli
A
decreased sensation
- edema and muscle pain
- paleness, decreased or absent pulses, coolness to the touch, weakness, spasm
4
Q
what is buerger’s disease
A
- inflammation of small.medium arteries and veins
- leads to bollackage of arteries of the lower legs and arms
- symptoms: color changes, temp changes, paresthesia, density to cold, thrombophlebitis, ulcerations
- SMOKERS, young men age 20-40
5
Q
what is peripheral material occlusive disease
A
- stenosis of artery walls
- common disease greater than 50
- men 5x greater than women
- fat and cholesterol congregate on arterial wall
- symptoms include leg pain worse with exercise and decreases with rest, numbness at rest, muscle pain, loss of hair, paleness cyanosis, weak.absent pose, difficulty walking
6
Q
How do the symptoms of ischemic rest pain present
A
- pain unrelated to exercise or exertion
- pain in the distal forefoot over the met heads
- aggravating factors - foot elevated in bed out of depend position
- relieving factor - dependent position to assist blood flow
7
Q
What is Raynaud
A
- bilateral vasospasm seen in hands and toes
- women 20-40
- trophic changes can occur including shiny and frail skin
- aggravated by cold, emotional swings and anxiety
- BILATERAL and progress from white (no flow), blue (vasodilatation), red (blood returns), normal
8
Q
What is polyarteritis Nodosa
A
- autoimmune disease causing necrotizing vasculitis of medium and small arteries
- adult men with hep B
- symptoms HTN, kidney failure, nausea, vomiting, abdominal pain, seizures, AMS HA, weakness, numbers, rashes
- may affect heart, brain, muscles, liver skin, kidney
9
Q
what are the different anatomical groups of veins in the leg
A
- subcutaneous/superfiscial
- deep/intramuscular
- perforating/communicating
10
Q
what are the major veins of the leg
A
- great saphenous (femoral triangle down the medial side of entire leg)
- small saphenous - down the middle of the posterior lower leg
11
Q
what is thrombophlebitis
A
- thrombotic occlusion prevent ing outflow of venous system
- can be deep or superficial
superficial - redness, warmth, TTP, edema, no serious circulatory effects
Deep- significant edema, inflammation - causes - trauma, muscle strain, blood dycrasias, prolong bed rest or reduced venous out flow
12
Q
what is the most common place of stasis ulcers
A
- working muscle have to shut the blood to the superficial veins due to increase IMP
- if the superficial system can’t handle the blood you get metabolic failure of the local system
- progressive disorder associated with chronic pooling of blood in the extremity
- medial malleolus is the most common site
13
Q
what arteries are you concerned about with humeral shaft fractures
A
axillary and brachial
14
Q
Why are vascular complications such a high concern with knee and elbow dislocations
A
there is only one vessel going to the lower half of the limb
15
Q
DVT rate post op without profolactice
A
50-60% - best thing is to get up and walk
16
Q
What is the Wells criteria for DVT
A
algorithm for detecting DVT
17
Q
what is a false aneurysm
A
- full thickness tear that is contained by the adventia or adjacent connective tissue of the artery
- most common finding is a palpable pulsating mass at the site of former trauma
- requires diagnostic testing with angiography or US
requires surgery to fix
18
Q
What do doppler vascular tests tell you
A
- speed and direction of blood flow
19
Q
What are normal ABI
A
Systolic ankle pressure / systolic arm pressure 1-1.4 - normal 0.9-1 - acceptable 0.8 - some disease less than 0.8 needs referral
20
Q
what is pulsed volume recording
A
measures changes in the volume of an extremity that occurs as blood flow to the extremity increases and decreases
- normal - wave form is a steep up slope, sharp peak and a concave down curve, down slop with a possible “dicrotic notch” indicating the closing of the aortic valve
- abnormal - decrease slope of the upslope, rounded peak and possible reversal of the downslope to a convex curve
- pathology is infront of one of the 4 measuring cuffs
21
Q
arterial injury occurs in what percentage of long bone fractures
A
0.6-3% with middle and distal femur the most common site
22
Q
what tests would help you differentiate an arterial disruption versus a compartment syndrome
A
- capillary refill and distal pulses
- arterial disruption they should be absent
- compartment syndrome they are often present
23
Q
what are hard signs of arterial injury
A
- pulsatile external bleeding
- enlarging hematoma
- absent dital pulses
- bruit with auscultation
- grossly ischemic limb (6Ps)
24
Q
what are the signs of ischemia
A
6 Ps
- pain
- paralysis
- pallor
- paresthesia
- pulselessness
- poikilotherm (coolness)
25
what is a bruit and how should you assess it
the abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction; or a localized high rate of blood flow through an unobstructed artery
- must auscultate
- Most occur only in systole, so the bruit is intermittent and its frequency dependent on the heart rate
- Anything increasing the blood flow velocity such as fever, anemia, hyperthyroidism, or physical exertion, can increase the amplitude of the bruit.
26
what are the compartment of the leg
- anterior
- lateral
- superficial posterior
- deep posterior
27
what is a major complication associated with compartment syndrome
REPROFUSION INJURY - as circulation is restored metabolic byproducts causes production of the oxygen free radical superoxide that damages the tissues and this requires medical management to prevent damage
28
what are the layers of the artery
- inner - intima
- media
- outer - adventia
29
What are the most common arterial diseases
1. emboli
2. thromboangiitis obliterans AKA Beurgher's disease
3. peripheral arterial occlusive disease
4. raynauds
5. hand vibration syndrome
6. polyarterieties nodosa
30
what are the common venous pathologies
1. thrombophlebitis (superficial and deep [DVT])
2. chronic venous insufficiency
3. varicose vein
4. stasis ulcers
31
what are the stages of lymphedema
stage 1 - spontaneous reversal with pitting edema
stage 2 - non pitting edema
stage 3 - irreversible edema with hardening of affected area
32
what is a arterial venous fistula
1. direct communication of the arterial and venous systems, skip the capillaries
2. The problem result from the low-hesitance flow circuit
- increase strain on the heart from increased cardiac output
- venous return is impaired secondary to increased demand on the system
- limb ischemia secondary to skipping of the capillaries
33
how does chronic arterial ischemia present
- muscle atrophy
- thick down curving nails
- skin is shinning and hairless
- dependent rubor - hyperemic (red) appearance of the skin in dependent position
- extremity edema from keeping the extremity in a dependent position to help with blood flow
- usually the distal toes
34
how does chronic venous insufficiency present
- skin is pigmented and brawny
| - ulceration in the ankle and distal calf, usually sparing the toes
