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What is an aneurysm?
An outpouching of the arterial wall
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What is a true aneurysm?
One in which the wall of the artery forms the aneurysm with at least one vessel still intact.
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What makes an aneurysm fusiform?
It is uniform in shape.
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What makes an anyeurysm saceurysm?
It is pouchlike with a narrow neck.
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What causes a false aneurysm?
Durin a test there is disruption of all layers of the arterial wall.
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How do we TX an aneurysm that is > 4cm?
Monitor unless its growing rapidly then we do surgery.
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What do we do for an aneurysm that is > 5cm?
Surgery!
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What is an aortic dissection?
A tear in the intimal lining of the arterial wall that allows blood to enter btw the intima and media, creating a false lumen. It's a tear in the arterial wall.
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S/S of an aortic dissection.
- Sudden severe CP
- Tearing sensation
- Change in LOC
- Dizziness
- Weakened carotid and temporal pulses
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What is the complication of Aortic dissection and describe it.
Cardiac Tamponade: blood escapes into the pericardial sac. May rupture and cause death.
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What should the mean arteral pressure be?
60
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How to you TX cardiac tamponade?
- < BP: use Arfonad and Nipride
- < contractility: beta blockers (Inderal)
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What causes peripheral arterial disease?
Atherosclerosis which narrows the vessel lumen.
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What is the classic SX of PAD of the lower extremities?
Intermittent claudication
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What will the skin of the legs look like with PAD?
- Thin
- Shiny
- Muscle atrophy
- Taunt
- Hairless
- < pulses
- Pallor or blanching
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What score from the ABI is a DX of PAD
< 0.9
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What is the drug TX for PAD?
- Antiplatelet: ASA or Plavix
- Intermittent claudication: Pletal or Trental
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Name the surgical TX for PAD
- Arterial bypass graph
- Endareriectomy
- Amputation
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How oftern should you monitor the extremities after surgery for PAD? What position should you avoid?
Q 15min
Knee flexed postion
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What is acute arterial ischemic disorder?
Occlussion that occurs suddenly.
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What are the SX of acute arterial ischemic disorder?
- The 6 s's:
- Pain
- Pallor
- Pulselessness
- Paresthesia
- Paralysis
- Poikilothermia
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What is Buerger's Disease?
A rare nonatherosclerotic, segmental inflammitory disorder of the medium sized arteries, veins, and nerves of the upper and lower extremities.
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What is the TX for Buerger's Disease?
Stop SMOKING
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What is the TX for raynauds phenomenon?
Calcium Channel Blockers: Procardia or Cardizem
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What is venous stasis?
Valve or muscle dysfunction of the heart.
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What are comlpications of a DVT?
- PE
- Chronic venous insufficiency
- Phlegmasia curulea dolens: swollen, blue, painful leg. There is so much edema that it presses on an artery and cuts off circulation.
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What are the drug TX for DVT?
- Heparin: monitor PTT
- Lovenox: low weight based heparin
- Coumadin: monitor PTT and INR
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What is superficial thrombophlebitis?
Palpable, firm, SQ cord like vein. Caused from IV therapy.
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What are varicose veins?
Dialated tortuous SQ veins.
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What is the TX for varicose veins?
- Schelotherapy
- Surgical ligation and dissection
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What chronic venous insufficiency and venous leg ulcers caused from?
The valves in the veins are damaged, which results in retrograde blood flow and pooling of blood in the legs and swelling.
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What are the SX of chronic venous insufficiency and venous leg ulcers?
- lower legs are leathery with brownish “brawny” appearance, bc RBC's leak out and die
- stasis dermatitis
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Where are venous leg ulcers located what do they look like?
- Above the medial malleous, wound margins are irregularly shaped and tissue is a ruddy
- color
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What is a PE?
Blockage of pulmonary arteries by thrombus, fat or air emboli
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What are the SX of a PE?
- anxiety
- sudden onset of unexplained dyspnea
- tachycardia
- cough
- pleuritic chest pain
- hemoptysis
- crackles
- fever
- accentuation of the pulmonic heart sounds
- sudden change in LOC
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What is the drug TX for a PE?
- Anticoagulant: Heparin or Coumadin
- tPA: to dissolve the clot
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Describe a closed amputation.
Performed to create a weight bearing limb. An anterior skin flap covers the bony part of the limb and makes it rounded for a prothesis.
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Describe a guillotine amputation.
It's cut straight across
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