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Etiology
- Left atrial embolic thrombus from atrial fibrillation
- Mural thrombus after myocardial infarction,
- Thrombus or emboli from abnormal or prosthetic heart valves
- Emboli (thrombus or atherosclerotic) from an arterial aneurysm (aorta, femoral, or poplite)
- Proximal atheromatous stenosis
- Trauma
- Iatrogenic
- Intra-arterial drug use
- Compartment syndrome
- Crush injury
Clinical Features
- Pain
- Pallor
- Pulselessness
- Paresthesia
- Perishingly cold
- Paralysis
Incomplete arterial occlusion, extensive necrosis will occur within 6 hours
Investigation
- serum lactate
- Coagulation
- ECG.
- CT angiography
ED Management
- Analgesia e.g. IV morphine 2.5 — 10mg titrated to response
- Intravenous heparinisation (heparin 5000units IV bolus then heparin infusion) to prevent clot extension and promote distal re-perfusion
- Urgent referral to a vascular surgeon (to consider intra-arterial thrombolysis, angioplasty embolectomy or surgical bypass grafting)
Complications
- Compartment syndrome
- K+ ions causing hyperkalaemia
- H+ ions causing acidosis
- Myoglobin, resulting in significant AKI
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