NURS N676 Acute Limb ischemia Information sheet

Acute Limb ischemia (ALI) Definition: Acute onset (2 weeks) ischemia is severe hypoperfusion of limb with signs and symptoms including pain, paralysis, paresthesia, pulselessness, cold, and pallor which threatens tissue viability. Usually due to acute arterial occlusion and rarely due to venous etiology. Criteria for diagnosis ! Must Be Recognized Rapidly. Skeletal Muscle Tolerates Ischemia 4-6 hours!  Onset 2 weeks  Category I*; Viable: limb not immediately threatened; No muscle weakness; No sensory loss; Audible arterial and venous doppler  Category II a*; Marginally threatened and salvageable if treated promptly: Mild to moderate motor or sensory loss; Inaudible arterial and audible venous doppler  Category II b*; Immediately threatened and possibly salvageable if treated immediately; Mild to moderate motor or sensory loss; Inaudible arterial and audible venous doppler  Category III*; Irreversible: Permanent nerve damage or major tissue loss; Profound sensory loss; Profound muscle weakness or paralysis; Inaudible arterial and venous doppler *Categories based on AHA/ACC guideline definition  Ankle Brachial Index 0.5 indicates severe arterial disease  CT and MR angiography can reliably diagnose the location and severity of arterial stenosis or occlusion (not good for  Arteriography can usually distinguish between thrombosis and embolism  Diagnostic imaging for immediately threatened extremity should be arranged in surgical suite Clinical presentation (Subjective Information)  Depends on etiology and whether patient has underlying peripheral artery disease  In patients without history of vascular disease symptom onset is more rapid due to lack of functioning collateral blood vessels. Sudden development of ischemic symptoms in previously asymptomatic patients is a sign of embolus  Six Ps is the classic presentation acute arterial occlusion: o Pain, Pallor, Poikilothermic, Pulselessness, Paresthesia, Paralysis  Other symptoms may include: