Peripheral Vascular Emergencies
March 2018 | by EMauthor
Acute limb ischaemia Can be either embolic in patients with a source of systemic embolisation such as Atrial fibrillation, mural thrombus following acute MI or abdominal aortic aneurysm. Or it could be Thrombotic in patient with existing symptomatic peripheral vascular disease. The classical features of acute limb ischaemia •Pain •Pallor •Parasthesia •Pulselessness •Paralysis •Perishing cold Management •Check all the peripheral pulses in all 4 limbs using palpation or Doppler probe •Obtain an ECG looking for AF or cardiac ischaemia •Provide adequate pain relief, ideally IV opiate titrated to the patient’s needs •Obtain venous access and send blood for FBC, U&Es, LFT, Clotting screen and G&S •These patients need to be referred urgently to surgeons if the limb is to be saved. •They also need anticoagulation but that should be done after consultation with surgical team Varicose veins •These may bleed and the bleeding can be profuse •Apply non adherent dressing and pressure bandage with elevation of the leg •Observe the patient for one hour+ in the department •Resuscitate and give blood if you suspect the bleeding was excessive •Consider 1 gm TXA •Consider admission for those who continue to bleed through bandage |
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