Acute Limb ischemia in elderly

[KMATTOX at aol.com]

In a message dated 12/2/2007 12:44:03 P.M. Central Standard Time,  
shebrain1 at yahoo.com writes:

:
1. Could this pt develop severe DIC with clot to Right  (intact) leg vs. 
clott triggered by the sheath.
NO, her problems are initially technical, predictable, reproduciable, and  
have happened in all of our cities, and very often go un reported as a "natural  
course of disease."
 
 

2. if we suspect AAA rupture, is there any role for US at bed  side, if not 
and pt is unstable at this point, is DPL going to help.
 
NOPE.   That decision and discussion should have occurred pre IR  and if that 
discussion and decision tree was not fully understood by patient,  family, 
surgeon, etc. etc.   then it should have been 

3. could the tPA quickly accelerate her AAA rupture.    NOPE
 
NOPE.   Do not go there.  It is not  required.   The explanation of this is 
straightforward and  predictable.    I have seen it far to often, especially  
among those who are young and eager.     

4. anything to be done differently in this patient.
 
At this point, NO,    If she is still alive, hang  crepe.   (A term to tell 
family to anticipate  death).    ANYTHING (ANYTHING) more that you do at this 
point  will make the ultimate and additional complications and death much more  
expensive, painful for the patient and frustrating for the doctors, nurses,  
administration, and whoever pays the bills.     
 
k






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