Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

Arterial Embolus 157

➣Pallor

➣Paresthesia

➣Pulselessness

➣Paralysis (ominous+late sign)

■Level of clinical ischemia is generally one anatomic level below the

arterial occlusion

tests

Blood

■Creatine kinase (rhabdomyolysis)

■Blood gas and electrolytes (lactic acidosis, hyperkalemia)

Urine

■Urine myoglobin (from muscle necrosis)

Specific Tests

■Doppler determination of pulses

■Allows comparison with other limb when those pulses are not pal-

pable

Angiogram

■Usually unnecessary when clinical presentation is obvious

■Needed in patients with underlying peripheral occlusive disease

where question of arterial thrombosis vs. embolus arises

differential diagnosis

Arterial Thrombosis

■Chronic ischemic changes in contralateral limb as atherosclerosis is

usually symmetrical (but 40% of embolus pts have occlusive changes

due to assoc. athero)

■History of prior peripheral vascular bypass

■Generally has slower onset

■May require angiogram to differentiate from embolus

Aortic Dissection

■Back, chest and abdominal pain

■Both legs are usually involved in dissection

■Rarely causes severe peripheral ischemia

■Confirm diagnosis with aortic imaging (MR, CT, TEE, etc.)

Neurological Paralysis

■Check pulses in all pts alleged to have neuro cause of paralysis or

paresthesia