What to ask
- •6 Ps: pain, pallor, pulseless, paraesthesia, paralysis, perishing cold
- •Onset (sudden = embolus, gradual = thrombotic)
- •AF, recent MI, peripheral arterial disease, previous bypass
What to examine
- •Both limbs — colour, temperature, capillary refill
- •Pulses — femoral, popliteal, posterior tibial, dorsalis pedis
- •Sensation and power (paralysis = Rutherford III, threatened)
- •Cardiac — AF, murmur
Essential investigations
- •Handheld Doppler
- •Bloods: FBC, U&E, clotting, lactate, group & save
- •ECG
- •CT angiogram once discussed
Immediate management
01 — Analgesia
IV opioids titrated.
02 — Anticoagulate
Heparin bolus + infusion (after vascular discussion).
03 — Keep limb dependent and warm
Do not apply heat directly.
04 — NBM
Likely theatre / IR.
What the registrar will ask
- 01Rutherford class?
- 02Pulses on Doppler?
- 03How long has the limb been ischaemic?
- 04AF or known PAD?
- 05Heparinised?
Referral checklist
Ready-to-refer score: 0% — gather the remaining items before calling.