VASCULAR

emergency

RM AW AN IS MAIL M D
DA
HO RA CIC & VA SCU LAR
CARDIOT
SURGEON
Solo - Indonesia
 Major complains
Trauma VS non trauma cases
Extremely painful
Bloody
 How to diagnose..?

Clinically!!!
Distal evaluation ( CRT, pulse oxymetry )
Imaging study
Invasive procedure
 Trauma cases
emergency
Hard sign
Active bleeding
Expanding hematoma
End-organ ischemia pulseless, palor, paresthesia, pain,
paralysis
Palpable thrill & bruit
Shock Hypovolemic
Emergency life & limb
 Trauma cases
emergency

Hard sign
Active bleeding
Expanding hematoma

End-organ ischemia pulseless, palor, paresthesia,

pain, paralysis, poikilothermia
Palpable thrill & bruit

Emergency of limb distal

evaluation !!!!
 How to manage..
Stop bleeding & resuscitation
Traction & splinting
Send to trauma center
Vascular surgeon
Specific imaging study
 Non trauma cases
Arterial diseases
 Acute Limb Ischemia
Pathophysiology
Metabolic syndrome and reperfusion injury,
Thrombo-embolism (dysritmia)
Clinical classification
I. Viable
II. Threatened
a. Marginally
b. Immediately
III. Irreversible

Clinical diagnosis ( Five Ps) or 6 Ps

Pain, pulselessness,pallor,paresthesia and paralysis (+)
poikilothermia
Other emergency
case

acute limb
ischemia
Etiology of Acute Limb Ischemia
1.Embolic Occlusion
Origin of arterial emboli
* Arterial fibrillation
* Rheumatic MS(90% from heart)
* Myocardial infarction
Less common causes
* Debris from aneurysm * Prosthetic heart valves
* Debris from ateriosclerotic plaques
* Left atrial myxoma * Ventricular aneurysm
* Bacterial endocarditis * other

2.Acute Arterial Thromboembolism

3.Bypass Graft Thrombosis
4. Other
 Diabetic Foot gangrene

Diabetic foot ulcer gangrene

lower extremity crepitation !!!
 Non trauma cases

VEIN Diseases
 Deep Vein Thrombosis (DVT)

Most likely to occur in deep

veins of the calf (80%)
25% of thrombi that occur
in calf will extend to the
popliteal & femoral veins
PE may be the first sign of
DVT
 DVT Manifestations
When clot is in formative stage, may notice no
symptoms
Usually profound tenderness; affected
extremity may be larger (unilateral edema)
Dull aching esp when walking: Most common
Severe pain, esp when walking
Cyanosis of extremity
Slightly elevated temp
General malaise
Venous thromboembolism
 VENOUS THROMBOEMBOLISM PULMONARY
EMBOLISM
Dyspnea, tachypnea,
or pleuritic chest pain
most common
Pleuritic pain = distal emboli
pulmonary infarction and pleural
irritation
Isolated dyspnea of rapid onset=
central PE with hemodynamic
sequlea
Retrosternal angina like = RV
ischemia

Syncope=rare
presentation, but
indicates severely
reduced hemodynamic
reserve
P
E
 Whats the benefit of early
referral?
Diagnostic & Drug management
Doppler vascular
Msct angiography
arteriography
Conventional surgery
Bypass
Trombectomy fogarty
endovascular surgery
 Conclusion
Every doctors should aware about
vascular problem
Referral time & accuracy is important

early diagnostic & treatment better

result
Thank you