Overview and priority post-operative assessment for carotid endarterectomy

Carotid endarterectomy is a procedure performed to repair and restore carotid arterial function when the artery is narrowed or occluded (arterial stenosis). Patients with narrowed carotid arteries may experience symptoms related to decreased cerebral blood flow and oxygenation. Most often the arteries are narrowed or occluded with atherosclerotic plaques and other products that you definitely don’t want there, including platelets and other inflammatory related goodies. Symptoms of carotid stenosis depend on the area of the brain affected but can include: paresthesia or numbness on one side of the body; slurred speech; and momentary loss of vision.

How can I get my own carotid endarterectomy?
You can develop carotid stenosis with hard work and a diet consisting of high fat, high cholesterol, and high sodium. Smoking is also an excellent fast-track to a variety of ailments not excluding carotid artery dysfunction. Other factors that may put someone at risk include: hypertension, obesity, uncontrolled diabetes or high blood sugars, and older age. As carotid stenosis can cause transient ischemic attacks (TIA) and cerebral vascular accidents (CVA), treatment is aimed at opening the narrowed artery and restoring adequate blood flow.

A do-it-yourself guide to the carotid endarterectomy
Diagnostic procedures are performed (Doppler studies, angiogram) to determine the severity of the occlusion and the appropriate method of treatment. A carotid endartectomy is performed when the artery has approximately 30% or less of the normal diameter available for blood flow. An incision is made into the neck and the artery is exposed. The artery is then stripped and cleaned out essentially, removing whatever junk you have piled up and then replacing the artery in its appropriate location.

Priority post-operative assessment

Potential for respiratory impairment (due to swelling/edema; close proximity to the trachea; hematoma formation; hemorrhaging artery)
ASSESS FOR signs of respiratory distress including tachypnea; dyspnea; nasal flaring; stridor; decreasing oxygen saturation; change in pulse (rhythm, rate, quality) -->hypovolemic shock; use of accessory muscles; difficulty communicating; changes in LOC; and difficult cough; and trachea assessment for midline deviation

Potential for bleeding due to disruption of a major artery
Assess for signs of bleeding and hematoma formation at the incisional site. Look for: frank hemorrhage from the site (>200cc); a hard lump that forms on or near the incision; unusual bruising; and a change in VS (decrease in BP, increase in P, sweating, loss of consciousness.

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