Pediatric emergency medicine trisk 2956 2956
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (71.17 KB, 1 trang )
well. Consequently, hemoptysis, hematuria, hypertension, abdominal pain, or melena
may signify vascular involvement, including infarction. Capillary and venous
inflammation typically involves the same organs, although the lower volume of blood
flow through these vessels tends to make capillaritis and venulitis less of an acute
emergency than arteritis.
Triage Considerations
Patients with a known diagnosis of a vasculitis will usually be taking
immunosuppressant medications. Workup of fever should be expedited. The patient
may present with life-threatening complications in any body system, including organ
systems with new involvement.
Clinical Assessment
Whenever vasculitis is considered as a diagnosis, a thorough history and careful
general physical examination should be augmented by a focus on clinical features of
vascular disease. All pulses must be palpated carefully, and bilateral Allen tests should
be performed to confirm patency of the radial and ulnar arteries and volar arch. The
neck, abdomen, and proximal extremities should be auscultated for bruits, and blood
pressures in all four extremities should be compared for asymmetry. The skin should be
examined carefully for lesions that are nodular or do not blanch, and the two other
windows on small-vessel abnormalities—ocular fundi and nailbed capillaries—should
be assessed as well.
Laboratory studies specific for the diagnosis of vasculitis are not yet available. When
vasculitis is being considered, laboratory investigation should include a CBC and
acute-phase reactants (especially erythrocyte sedimentation rate [ESR] and CRP) for
evidence of systemic inflammation. Ongoing immune activation leads to
hypergammaglobulinemia in many cases of systemic vasculitis. Certain small-vessel
diseases (especially granulomatosis with polyangiitis [GPA, formerly Wegener
granulomatosis] and eosinophilic granulomatosis with polyangiitis [EGPA, formerly
Churg–Strauss syndrome]) are characterized by ANCAs. These are the so-called
ANCA-associated vasculitides. The von Willebrand factor antigen is released by
damaged vascular endothelium. It is elevated in small-vessel vasculitides but also in
other conditions that cause vessel damage, including stroke, trauma, and severe
infections, rendering it nonspecific.
Imaging procedures should be used to confirm a clinical suspicion of vasculitis, not
to hunt blindly for a diagnosis. When pulmonary involvement is suspected, pulmonary
function tests and imaging of the lungs with radiographs or CT are often useful.
Vascular imaging must be selected on a case-by-case basis, based on clinical and
laboratory data. Doppler ultrasound studies and CT or MRI angiograms are adequate
for identifying abnormalities in large- or medium-sized vessels, but conditions
