NE
Forum Guru
Topics: 53
Posts: 504
|
54 y old man comes to the ER with acute onset of a cold blue left foot. No significant medical history. He is a smoker ( 3 packs/day).Ph E- no palpable or dopperable dorsalis pedis/ posterior tibialis pulse, normal pulse on the right side. Next step in management:
A. angiogram
B. place on iv heparin
C. MRI
D.place on streptokinase
E. embolectomy
|
| Luckyall
Forum Guru
Topics: 11
Posts: 592
|
is it buerger dis ? so i'd guess angiogram is next step ?
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
I was thinking-anyways,angio is going to tell that there is a block which we already know by clinical symptoms and history..Why can't we start I>V heparin since q says acute and exact hours has not been given for the choice to be i.v streptokinase?!Comments please!
|
| new_n_lost
Forum Hero
Topics: 724
Posts: 6,393
|
My initial guess is still do an Angiogram it will tell u where the Blockage n then Proceed with a Embolectomy cos if we give him Streptokinase or Heparin it will lead to further insult elsewhere cos it can lead to Embolization. But here we have a COLD BLUE FOOT So Angiography might delay the prognosis of Foot Revascularization. If it were an Slightly Marble white Appearence or a Light Blue Appearence then we can go for Angiogram.
The Rule is if its a Acute Setting With Presence of Previous Claudication History with Contrlateral Pulses Absent then go For Angiograpy n then Heparin
If there is no Previous History n Contralateral Pulses r present then the Diagnosis is Clinical n Embolectomy with Warfarin therapy
Abstract from :- http://www.bmj.com/cgi/content/full/320/7237/764
___________________
"never argue with a fool, they'll bring you down to their level and beat you with experience" FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| r_albayunen
Forum Senior
Topics: 0
Posts: 218
|
angio
|
| Justice
Just signed contract
Topics: 118
Posts: 2,372
|
(A)
___________________
The winner takes it all...
|
| NE
Forum Guru
Topics: 53
Posts: 504
|
sorry guys! you have to think what is " THE FIRST STEP IN MANAGEMENT"!
|
| Adam
Forum Senior
Topics: 6
Posts: 136
|
E ?? 
___________________
I will not say I failed 1000 times.. I will say that I discovered there are 1000 ways that can cause failure ..
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
I will still go for B.Start I.V.Heparin
|
| new_n_lost
Forum Hero
Topics: 724
Posts: 6,393
|
E. embolectomy ???
___________________
"never argue with a fool, they'll bring you down to their level and beat you with experience" FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| NE
Forum Guru
Topics: 53
Posts: 504
|
B- begin heparin and, after this, go to embolization.
|
|
| |
| | | | | | | | | | | |
Similar forum topics