UMEM Educational Pearls

Title: What's the Diagnosis?

Posted: 1/9/2017 by Tu Carol Nguyen, DO
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Question

A 60 year-old man with history of atrial fibrillation, CAD presents with left lower leg/foot pain for a few days. His foot is seen below. What's the diagnosis?

Answer

Mottling with concerns for Acute Limb Ischemia

Key Points:

Assess appearance, temperature, sensation, strength and pulses
Remember 6 P's (paresthesia, pain, pallor, pulselessness, poikilothermia, paralysis)
Irreversible tissue necrosis can occur by 6 hours from onset
Start IV Heparin bolus (100 units/kg or 5000u) and continuous IV infusion (1000 units/hr) with considerations for any contraindications
Immediate vascular consult

References

Creager MA, Kaufman JA, Conte MS. Clinical practice. Acute limb ischemia. N Engl J Med. 2012;366(23):2198-206.

http://www.emdocs.net/acute-limb-ischemia-pearls-pitfalls/