Category: Cardiac

Cervical (Carotid OR Vertebral) Artery Dissection

Cervical artery dissection is a rare but significant cause of stroke and headache/neckache, which is easy to overlook. Leading to a typically delay in diagnosis of 7 days. Unfortunately imaging the cervical arteries is not simple, with MRA being the method of choice. Hence these patients must be referred to the “Stroke Consultant”.

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Pulmonary Embolism – PE

PE is somehow both the most over and under diagnosed condition. with severity ranging from the questionable sub-segmental PE to the Massive PE (an indication for thrombolysis). So think:

  • Does this presentation sound like a PE? – If not STOP here
  • Pregnant?  – Click Here
  • Do you think this is likely a PE? (if so you can’t use PERC)
  • Does D-Dimer answer  your question? (whats the Wells)
  • Massive PE  – think Thrombolysis
  • Sub-Massive PE – there is lots of debate (involve seniors), locally needs 2 consultant sign off and not considered time critical.

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Malignant/Accelerated Hypertension

There are several terms commonly used “Accelerated Hypertension”, “Hypertensive Emergency”, “Malignant Hypertension”. They all have a very similar definition (ESC/ESH, NICE, ACEP)

Patient has both:

  1. Blood pressure: Systolic ≥180mmHg OR Diastolic ≥110mmHg (often >220/120mmHg)
  2. End-Organ Damage: Retinal Changes, Encephalopathy, Heart Failure, Acute Kidney Injury, etc.

Mortality has improved in recent years with 5yr survival of 80% if treated. However, untreated average life expectancy is 24 months.

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Atrial Fibrillation/Flutter (AF) – ESC 2020

Before you start 

  • Whats the cause? – treating the precipitant often sorts the AF (adding B-Blockers to Sepsis can make things worse)
  • Stable or Unstable?  – Electricity vs. Drugs
  • CHADS-VASC vs. HASBLED – Anticoagulation
  • Rhythm vs. Rate control??
  • NEW Symptomatic Arrhythmia Clinic – referral form attached tho the PDF

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Vascular Emergencies (Regional Pathways)

Intro

Vascular surgery has been reconfigured across etc region. The vascular oncall will be based at BRI 24/7.

Multiple pathways have been developed below to help guide appropriate use – full guide HERE

AAA (Symptomatic)
 
AAA (Incidental)
 
Ischaemic Limb (Acute)

Ischaemic Limb (Critical)

Ischaemic Limb (Intermittent Claudication)
 
Uncontrolled Haemorrhage (Interventional Radiology)

Some patients benefit from control of bleeding using embolization techniques, which is a procedure performed by an Interventional Radiologist.

Patients should be treated in their receiving hospital to the maximum of that hospital’s capability, where at all possible. When all local treatment options have been exhausted, the patient should be discussed with one of the Arterial Centres (BRI) with a view to transfer for ongoing management by IR techniques.

Isolated Vascular Trauma

Diabetic Foot

Emergency Transfer

Urgent Vascular Clinic

Access is very limited to this clinic. It is envisioned by WYVas that access to UVAC for ED patients will be arranged through direct (telephone) referral to either:

  • IN hours: Local (HRI) or ON-Call (BRI)Vascular Consultant
  • OUT of hours: ON-Call (BRI) Vascular Consultant