A case of Acute Limb Ischemia

8/14/2019 A case of Acute Limb Ischemia

1/13

My hand is bluer than blue

A case of a 39 year old male with cyanosis and numbness of the distal

phalanges of the left hand

Angelo P. Ampong, MD

Emergency Medicine Resident

East Aenue Medical !enter

HISTORY OF PRESENT ILLNESS

Patient is a 39 year old single unemployed male from Payatas !ue"on #ity $%o

&ame in $it% a &%ief &omplaint of &yanosis of t%e left finger tips' (t appro)imately

*am patient e)perien&ed sudden &yanosis num+ness and tingling sensation of t%e

distal p%alanges of t%e left %and' Patient soug%t &onsult at a lo&al &lini& +e&ause of

persisten&e of pre,ious symptoms' He $as found to %a,e a -P of .*/0.// on t%erig%t %and +ut a+sent +lood pressure and radial pulse on t%e left %and' Patient $as

ad,ised to see1 furt%er e,aluation from a tertiary %ospital'

RE2IE OF SYSTE4S

567 anore)ia 567 $eig%t loss 567 malaise 567 fe,er

567 &%est pain diffi&ulty of +reat%ing 567 ,omiting a+dominal pain diarr%ea

567 dysuria

PERSON(L SO#I(L HISTORY

Non smo1er

O&&asional (l&o%oli& +e,erage drin1er

No inta1e of illi&it su+stan&es

F(4ILY HISTORY

587 Hypertension 6 4ot%er 567 ia+etes 567 PT-

567 (st%ma 567 #ardia& disease 567 T%yroid disorder


2/13

PHYSI#(L E:(4IN(TION

#ons&ious &o%erent am+ulatory not in distress

-P; "#$%"$$ 5R(7 no appre&ia+le -P 5L(7

HR; *< RR; .9 Temp; 3


3/13

#OARSE (T THE E4ERBEN#Y EP(RT4ENT

9;C* pm (T

R(; .*/0.// I2F; PNSS .L ) DH

L(; / Diagnostics&

pulses #:R P6(

R(; 88 #-#

L(; / PT aPTT

Na -AN &rea

.CL E#B

T%erapeuti&s;

gi,e (spirin D/ mg0ta+ ta+s &%e$ed P'O'

gi,e #lopidogrel *> mg0ta+ ta+s PO

"$&3' pm gi,e Heparin


4/13

pulsesR(; 88 L(; /

Hemoglo+in .9C g0L 5H7 ./6.*/

Hemato&rit /'>*> 5H7 /'/6/'>/

-# *'* )./90L

Neut /'*< ?

Lym /'.D ?

4ono /'/< ?

Platelet .*> )./90L

4#2 .//'D fL 5H7 D/6.//

4#H 33'* pg 5H7 C*63.

4#H# 33> g0L 3C/63'> ? 5H7 ..'

INR .'9*

#ontrol .3' per&ent &onfiden&e inter,al /'.> to

.'.> PJ/'/97 and t%e ris1 of t%e &om+ined end point of nonfatal myo&ardial

infar&tion nonfatal stro1e pulmonary em+olism ma=or ,enous t%rom+osis or deat%

from &ardio,as&ular &auses 5relati,e ris1 /'/ 9> per&ent &onfiden&e inter,al /'.Dto /'9. PJ/'/37'

O,erall mortality and &ardio,as&ular mortality $ere not redu&ed signifi&antly'

T%e in&iden&e of ma=or +leeding episodes $as not signifi&antly in&reased in t%e

aspirin group 5relati,e ris1 .' per&ent &onfiden&e inter,al /'C* to 9'*.7'

#ON#LASION


13/13

Lo$6dose aspirin &an safely pre,ent t%rom+oti& &ompli&ations in patients $it%

poly&yt%emia ,era $%o %a,e no &ontraindi&ations to su&% treatment

A case of Acute Limb Ischemia

Documents

Transcript of A case of Acute Limb Ischemia