Practice Quiz

CMC Cardiac Medicine Certification

Category - CMC

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A patient with a history of atrial fibrillation goes to the emergency room with complaints of severe pain in his left lower limb for the last three hours. Now, it has progressed to loss of sensation and feelings of cold and numbness. What is the first action the nurse should take to manage this patient?
  1. Send the patient for arteriography
  2. Immediate heparinization
  3. Prepare the patient for embolectomy
  4. Wait for doctor to check the patient
Explanation
Answer- B - The nurse should do immediate heparinization with 5000 IU bolus and continuous infusion to maintain PTT > 60. The symptoms of this patient are highly suggestive of acute arterial occlusion.
Management of acute arterial occlusion:
•Immediate heparinization at 5000 IU bolus and continuous infusion to maintain PTT > 60
•In the absence of power and sensation - need emergent re-vascularization: for embolus - embolectomy; (ii) for thrombus - bypass
•In the presence of power and sensation - need work-up - including angiogram: for embolus - embolectomy; (ii) for thrombus - bypass
•Embolectomy: Fogarty catheter tied to fish embolus out of artery
•Bypass: bypass occlusion allowing blood flow to resume to distal site
•Identify and treat underlying cause
•Continue heparin post-op, start warfarin post-op day 1 for 3 months
•Re-perfusion phenomenon
•Toxic metabolites from ischemic muscle --> renal failure and multi-organ system failure
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