A patient with atrial fibrillation is presents with acute pain in left lower limb which progressed to loss of sensation and feeling of cold and numbness over few hours. What is the first treatment the nurse should start?

Question

Quizplus · Accepted Answer

The first treatment the nurse should start is 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

A Patient with Atrial Fibrillation Is Presents with Acute Pain