Page 65 - Virtual Vascular Vol 17

This 81 year old gentleman was recently admitted to ICU with severe pneumonia
requiring double strength noradrenaline.

During his stay, it was already noted that his finger tips and toes were dusky looking.
Whilst his toes and right finger tips slowly improved as pictured, his left finger tips
became permanently ischemic.

Previous arterial line had been set on the right radial artery.

Bilateral upper limb pulses were strong. The hands were warm and pink. There was no
scar or aneurysm detected.

There was no atrial fibrillation on ECG and no other signs of prior myocardial infarction
or infective endocarditis.

An ultrasound duplex confirmed patent bilateral upper limb arteries except an
incidental finding of occluded distal ulnar artery.

The lesson is that high dose vasopressors can lead to digital ischemia. 65