Acutely Painful Limb

Question 1

How should any acutely painful limb that is cold and pale be treated?

Answer 1

As acute limb ischaemia until proven otherwise

This is a surgical emergency

Question 2

6 Ps of acute limb ischaemia

Answer 2

Pain

Pallor

Pulselessness

Paraesthesia

Perishingly cold

Paralysis

Most will only initially present with pain, pallor and pulselessness

Question 3

c

Answer 3

Examin the contralateral limb

Any patient with a full complement of pulses in one leg and no in the other which is symptomatic, needs urgent intervention.

Also ask about any risk factors

Question 4

Risk factors of ALL

Answer 4

AF

HTN

Smoking

DM

Recent MI

Question 5

What should be done if ALL is suspected.

Answer 5

CT angiogram urgently + urgent vascular review.

ALL is a surgical emergency and irreversible tissue damage occurs within 6 hours.

Patients should be sufficiently resus and started on IV heparing whilst decisions for definitive vs conservative management is done.

Question 6

What is a sudden onset of hot and swollen limb usually suggestive of?

Answer 6

Potential DVT

Cellulitis

Question 7

Ix and management of acutely painful limb.

Answer 7

Make sure they are haemodynamically stable.

Document neurovascular status

ALL -> CT angiography and IV heparin

DVT -> Well’s score, Doppler + D-dimers

Routine bloods + G&S should be done and sufficient analgesia