Arterial Disease of Limbs: Acute Limb Ischaemia

Question 1

What can happen in the leg to cause acute limb ischaemia

Answer 1

Emboli
Thrombus
Trauma
Dissection

Question 2

What to look for in history?

Answer 2

Onset
Duration
Do they have CLI
Do they have the risk factors for CLI

Question 3

What are the 6Ps of presentation?

Answer 3

Pain 
Pallor
Perishingly cold
Paraesthesia
Paralysis
Pulseless

All these should be compared to contralateral limb

Question 4

What is paraesthesia?

Answer 4

Tingling/burning sensation under skin

Question 5

How is ALI managed initially?

Answer 5

ECG monitoring
Bloods
Nil by mouth - analgesia and anticoagulates

Question 6

What is the long term plan if the limb is salvageable?

Answer 6

If emboli suspected - embolectomy

If thrombosis - surgery or thrombolysis therapy

Question 7

What is a embolectomy?

Answer 7

Emergency surgical removal of an emboli blocking circulation

Question 8

What is the long term plan if the limb is not salvageable?

Answer 8

If the patient is willing/fit to amputate - amputate

If not palliate

Question 9

What does palliate mean?

Answer 9

make (a disease or its symptoms) less severe without removing the cause.

Question 10

What is compartment syndrome?

Answer 10

Painful condition caused by pressure within the muscles builds to dangerous levels.

Often caused or related to acute limb ischaemia

Question 11

What can compartment syndrome cause?

Answer 11

Muscle ischaemia
Venous obstruction
Inflammation
Oedema

Question 12

Signs of compartment syndrome?

Answer 12

A tense tender calf
A rise in creatine kinase
Rise of myoglobulinaemia - renal failure