10/11: Vascular Disease - Dayton

Question 1

most common arterial vascular disease

Answer 1

atherosclerosis

Question 2

pathology of atherosclerosis

Answer 2

• eccentric plaque deposition
• narrowing of central lumen (oval contour of external surface, rounded contour of lumen)
• calcification

Question 3

where does DVT occur with diabetic?

Answer 3

• earlier age
• more severe
• leg trifurcation

Question 4

clinical manifestations of PVD

Answer 4

• diminished or absent pulses
• leg painwith walking/claudication
• ischemic rest pain
• slow healing wounds
• tissue damage (ulcer, gangrene)

Question 5

buerger’s sign

Answer 5

pallor on elevation

Question 6

ulcers occurring distally

Answer 6

ischemic ulcers

Question 7

describe ischemic ulcer

Answer 7

• occur distally
• severe pain
• little bleeding
• irregular edges
• poor granulation
• other signs of arterial insufficency present
• dry necrosis

Question 8

associated findings with ischemic ulcer

Answer 8

• claudication
• night pain/ rest pain
• dependent rubor
• elevation pallor
• skin atrophy
• nail dystrophy
• decreased skin temperature

Question 9

arterial thrombus vs. embolus

Answer 9

thrombus

• insitu clotting occluding the vessel
• gradual onset of worsening ischemia
• signs of arterial disease
• atheroma already present

embolus

• sudden and severe
• no preexisting arterial symptoms
• identifiable source of free body (afib)
• signs of PAOD not necessarily present

Question 10

episodic reduction in peripheral blood flow due to cold exposure or stress

Answer 10

raynaud’s phenomenon

- functional

Question 11

tx raynauds

Answer 11

• nifedipine
• IV prostacyclin or prostaglandin E1
• evening primrose oil

Question 12

normal resting venous pressure at ankle in standing position

Answer 12

60-90 mmHg

Question 13

describe venous pump

Answer 13

emptying the deep system decreases venous pressure, opening the valve and forcing blood from the superficial to the deep system

Question 14

hemodynamics of foot pump

Answer 14

direct stretching and compression of the plantar foot veins is the mechanism NOT muscular

Question 15

fibrin cuff ulcer theory

Answer 15

fibrin leaks out and is transformed to fibrinogen

cuff surrounding capillaries impedes oxygen - tissue exchange leading to tissue death

Question 16

white blood cell trapping theory ulcers

Answer 16

• distended v lead to decreasd velocity of blood flow
• WBC allowed to separate from plasma and migrate from vessel into tissue
• release of proteolytic enzymes contributes to endothelial and tissue damage

Question 17

symptoms of stasis

Answer 17

pain
burning
heavy feeling

Question 18

lipodermatosclerosis

Answer 18

• end stage
• severe induration
• tight bound skin
• sever scarring

Question 19

venous stasis ulcer

Answer 19

• large
• superficial
• irregular
• fibrous and granular tissue

Question 20

tx venous stasis ulcer

Answer 20

** treat edema

Question 21

compression goals for venous stasis therapy

Answer 21

40 mm/hg pressure at ankle –> 17 mmhg at the knee

Question 22

Law of laplace

Answer 22

pressure = 2 x tension / radius of leg

• wrapping at same tension the whole time creates a graduated tension in leg due to fact that radius of leg increases

Question 23

circumferential elastic bandaging _____ the result. Inelastic wraps or socks _______ the results

Answer 23

OBTAIN

MAINTAIN

Question 24

what does compression do?

Answer 24

• reduces venous hypertension
• increases venous return velocity
• reduces exudation from the vv into the tissue by reducing transmural pressure gradients, thereby reducing skin irritant factors
• improves arterial flow

Question 25

describe multilayer compression

Answer 25

• double cast padding layer from toes to tibial tuberosity

- two 6 in ACE bandages with 50% overlap form toes to knee

Question 26

pressure required to reveres chronic venous hypertension

Answer 26

40 mmHg

- hard to achieve with stockings or unna boot

Question 27

what is frostbite

Answer 27

• ice crystal formation in superficial or deep structures
• occurs when tissue heat loss exceeds the ability of local tissue perfusion to prevent freezing of tissues
• 4 phases: pre freeze, freeze thaw, vascular stasis, late ischemic

Question 28

when is sensation lost temp wise?

Answer 28

at 10 degree C

Question 29

hunting reflex (pre freeze phase)

Answer 29

• cold induced vasodilation
• episodes of transient vasodilation every 7-10 min
• disapperas with prolonged exposure to cold

Question 30

what phase do ice cystals form

Answer 30

freeze-thaw

Question 31

favorable prognostic factors for superficial frost bite

Answer 31

retained sensation
normal skin color
clear blisters only in distal phalanges

Question 32

poor prognostic features of deep frostbite

Answer 32

• non blanching cyanosis
• absent doppler pulses
• firm skin
• dark blisters or even worse - no blisters

Question 33

4 degrees of frost bite

Answer 33

1st: white/yellow raised plaque with numbness
2nd: superficial skin blisters, clear, erythema
3rd: deep hemorrhagic blisters
4th: necrosis extending into muscle and to bone, through the dermis

Question 34

field management frostbite

Answer 34

• treat hypothermia
• maintain hydration
• give 600 mg BID-QID ibuprofen (block inflammatory pathway)
• avoid re-freezing
• rapidly rewarm by water immersion bath 37-39 degrees C

Question 35

why give low molecular weigh dextran for frostbite?

Answer 35

• polysaccharide plasma expander

- decreases blood viscostiy and inhibits intravascular cellular aggregation and improves small vessel perfusion