5P sign

Introduction 5P sign, Pulselessness, Pain, Pallor, Paresthesia, and Paralysis are manifestations of arterial embolism in the limbs. This symptom needs to be noted in the compartmental compartment syndrome. .

Cause

The cause of the "5P" sign: mainly caused by limb arterial embolism, osteofascial compartment syndrome.

an examination

Related inspection

Angiographic vascular ultrasound

Diagnosis and examination of the "5P" sign:

Patients with structural heart disease, atherosclerosis, especially those with a history of atrial fibrillation or arterial embolism, such as sudden onset of limb pain with acute arterial ischemia and corresponding arterial pulsation disappear, also have "5P" The levy, the diagnosis of acute arterial embolism is basically established. The plane in which the skin temperature is lowered is one palm width (eg, arterial embolism) to one joint (such as femoral artery embolization), and the plane of skin color change, sensation, and movement disorder is often one to two joint planes lower than the embolization site. Clinically, it is usually easier to judge the location of embolization. If there are severe pain in both lower extremities and patients without pulse, such as the distal side of the abdominal aorta (equivalent to the umbilicus) can not touch the pulsation, the abdominal aorta may be very large. . One side of the lower extremity was severely painful, and the ipsilateral iliac femoral artery pulsation was invisible and often the ipsilateral radial artery embolization. Femoral artery embolization occurs when the brachial artery pulsates well without a femoral artery pulsation. When the femoral artery is pulsating and there is no arterial pulsation at the extremity, it is an embolism of the artery and its branches. The upper limbs can be deduced by analogy.

The Doppler blood flow meter can determine the exact location of the embolism because a relatively normal blood flow is heard in the proximal side of the obstruction, and the blood flow or signal on the distal side immediately disappears or is significantly attenuated. Recent experience has shown that the embolization site determined by Doppler flowmetry is consistent with the surgical findings. photography can also be used for embolization positioning. However, the above method cannot clarify whether the distal artery of the embolization is patency, the collateral circulation condition, and whether there is a secondary thrombus and its range and venous return. The use of selective limb arteriography and continuous radiography can fully understand the above conditions, and can be used if necessary and necessary. When CPK and LDH are significantly elevated, it suggests that muscle necrosis may have occurred. In addition, the cause of arterial embolism should be clarified by careful medical history and a comprehensive physical examination. 90% of patients have structural heart disease and arrhythmia, and a small number of patients have embolism caused by aneurysms in different parts or after heart valve replacement. Therefore, patients with embolic disease should carefully understand the cardiovascular system, and at the same time give appropriate treatment to reduce the operative mortality.

Differential diagnosis

The 5P sign is diagnosed with the following diseases:

(1) Arterial thrombosis The basis of the original arterial disease, such as arterial infarction, aneurysm, arterial trauma or arterial suture, anastomosis, transplantation or angiography, followed by thrombosis. It has the following characteristics: 1 has a corresponding medical history, such as symptoms of chronic ischemia, such as limb numbness, chills and intermittent claudication of the calf or femoral hip; 2 physical signs of chronic ischemia, such as hair loss, toe (refers to) A thickening deformation, femoral atrophy, etc.; 3X line plain film may show vascular wall calcification or bone sparse; 4 often have signs of arteriosclerosis in other parts; 5 the onset process is slower than embolization. Generally, angiography should be performed when the diagnosis is difficult. Because of the case of secondary thrombosis, it is often impossible to cure by arterial thrombectomy, and it is often necessary to perform vascular bypass grafting. When embolization occurs on the basis of arteriosclerosis, the condition is more complicated and it is difficult to prepare when handling.

(B) acute iliac vein thrombosis, that is, femoral bruises, sometimes confused with arterial embolism. When the acute iliac vein thrombosis occurs, the arteries are paralyzed, and the blood flow is slow, causing the affected limb to be pale or purple, cold, and weak in the extremities. However, the ischemic phenomenon improved after 12 hours: arterial pulsation recovered and skin temperature increased. In addition, the affected limbs are swollen, and there may be tenderness along the deep veins, shallow vein filling, etc., which is obviously different from arterial embolism. However, patients with increased disease can also cause gangrene.

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