UMEM Educational Pearls


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?




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


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