Things not to miss - Acute limb ischemia

An 80 years old lady presented to ETU with a history of severe right leg pain for 2 hours with sweating.

She was very ill on admission with profuse sweating and tachycardia. ETU doctor attached her to a multimonitor.

Her heart rate was 120/min and it was irregular. Blood pressure was 160/100mmHg.

Diagnosis of Atrial fibrillation was made. As it could be a myocardial infarction she was referred to the cardiologist. They suggested to start her on Aspirin, Clopidogrel, Atorvastatin and Enoxaparin. A blood sample was sent for Troponin I titre.

Two hours later, she was admitted to the medical unit.

House officer was concerned as the patient kept on complaining about the leg pain. He touched the limb to find it dead cold! There was no pulse. Saturation was undetectable!

Urgent arterial doppler showed complete obstruction of deep femoral artery. She was immediately sent for vascular intervention to save the ischemic limb.

Lesson

 ~ You can come to various diagnoses merely by examining and investigating a patient. But never ignore a patients presenting complaint.

~ 6Ps of acute limb ischemia

  • Pain
  • Pallor
  • Pulseless
  • Paresthesia
  • Paralysis
  • Perishingly Cold
~ Why not read about acute limb ischemia today?

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