It's 🥶 & we're coming across many cases of peripheral ischemia/gangrene
🔢The semiology of seizures is what we are all taught, but gangrene is another condition where history is the king 👑
🔁It's essentially a demand≠supply mismatch
#MedEd #MedTwitter #RheumTwitter
🔢The semiology of seizures is what we are all taught, but gangrene is another condition where history is the king 👑
🔁It's essentially a demand≠supply mismatch
#MedEd #MedTwitter #RheumTwitter
The 📝 goes on & so that we can save ⏳ & 💰 on the tests, I like to broadly divide the pathology into:
1️⃣Luminal: atherothrombosis, thrombosis (APLA, DIC), cryofibrinogenemia
2️⃣Vessel wall: vasculitis (ANCA, PAN, SLE),vasculopathy (scleroderma spectrum)
3️⃣External compression
1️⃣Luminal: atherothrombosis, thrombosis (APLA, DIC), cryofibrinogenemia
2️⃣Vessel wall: vasculitis (ANCA, PAN, SLE),vasculopathy (scleroderma spectrum)
3️⃣External compression
Q1️⃣: How was the onset?
🐌Insidious onset, gradual progression is the most common
➡️peripheral vascular disease
➡️most vasculitides
➡️vasculopathy
#MedEd #MedTwitter
🐌Insidious onset, gradual progression is the most common
➡️peripheral vascular disease
➡️most vasculitides
➡️vasculopathy
#MedEd #MedTwitter
⚡There are very few causes for bolt in the blue, acute gangrene with maximal involvement at the onset
➡️Cryofibrinogenemia (essential, post infective, autoimmune)
➡️Embolic (atheroembolic, infective endocarditis)
➡️Cryofibrinogenemia (essential, post infective, autoimmune)
➡️Embolic (atheroembolic, infective endocarditis)
Now before we move ahead,
Progression of ischemia means an increase in the area of involvement and NOT further blackening of the same area
So mark the demarcation line on Day1️⃣!!
Progression of ischemia means an increase in the area of involvement and NOT further blackening of the same area
So mark the demarcation line on Day1️⃣!!
Q2️⃣what are the associated features with #gangrene~most important to narrow down your differentials & prevent ordering a gamut of investigations
1️⃣ Old age, long standing DM/HTN, history of CVA/CAD➡️ atherothrombosis
2️⃣ Young♀️, recurring pregnancy 🤰losses, CVA➡️ #APlagueTale
1️⃣ Old age, long standing DM/HTN, history of CVA/CAD➡️ atherothrombosis
2️⃣ Young♀️, recurring pregnancy 🤰losses, CVA➡️ #APlagueTale
3️⃣ skin infarcts, nodules, skin ulcers, mononeuritis multiplex ➡️ vasculitis
(Also ask for specific features of ANCA associated #vasculitis, polyarteritis nodosa, #lupus, Sjogren, hepB/hepC)
4️⃣ #Raynaud's phenomenon, digital tip ulcers, pits➡️ vasculopathy (SSc, MCTD, lupus)
(Also ask for specific features of ANCA associated #vasculitis, polyarteritis nodosa, #lupus, Sjogren, hepB/hepC)
4️⃣ #Raynaud's phenomenon, digital tip ulcers, pits➡️ vasculopathy (SSc, MCTD, lupus)
5️⃣ 🏥 #ICU setting is another scenario wherein patients present with gangrene
⏩ Peripheral symmetric gangrene: hypotension, vasopressor use
⏩ DIC
⏩Post infective CAD/cryofibrinogenemia
⏩Cardiac emboli
👀 out for these!!
⏩ Peripheral symmetric gangrene: hypotension, vasopressor use
⏩ DIC
⏩Post infective CAD/cryofibrinogenemia
⏩Cardiac emboli
👀 out for these!!
6️⃣ history of infection, dipping hands/feet in cold water, involvement of ears/nose, maximal involvement at onet➡️ #cryofibrinogenemia
7️⃣ Do screen for danger symptoms/signs of #malignancy
7️⃣ Do screen for danger symptoms/signs of #malignancy
Q3️⃣ site of involvement?
🦵- peripheral vasc disease, buerger's
✋Hands- vasculopathy
Both 💪🦵- vasculitis
🥶Cold exposed- cryofibrinogenemia
🦵- peripheral vasc disease, buerger's
✋Hands- vasculopathy
Both 💪🦵- vasculitis
🥶Cold exposed- cryofibrinogenemia
Q4️⃣Don't forget to enquire about smoking 🚬!
Both active and passive!
Buerger's disease is quite common, lower limb predominant, associated with superficial thrombophlebitis.
Both active and passive!
Buerger's disease is quite common, lower limb predominant, associated with superficial thrombophlebitis.
🫠Last but not the least !!
Do not wait for the test reports for initiating treatment for peripheral ischemia!!💊 💉
It's alright to initiate a cocktail of drugs till the etiology is clear.... precious time needn't be wasted! ⏳
#MedEd #MedTwitter
Do not wait for the test reports for initiating treatment for peripheral ischemia!!💊 💉
It's alright to initiate a cocktail of drugs till the etiology is clear.... precious time needn't be wasted! ⏳
#MedEd #MedTwitter
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