Emergencies

Question 1

Signs of acute limb ischaemia

Answer 1

Pain

Pallor

Pulseness

Paraesthesia (Anaesthesia)

Paralysis

Perishingly cold (poikilothermia)

If the patient has a neurological deficit, urgent revasculairsation is required.

Look for precipitating cause of acute limb ischaemia:
AF, MI, aneurysm, dissection, trauma,

Question 2

Immediate management of acute limb ischaemia

Answer 2

High-flow O2

IV access and IV crystalloid

Opiate: 5mg morphine IM

Heparin 5000 units IV bolus

Call for help

Duplex USS, DSA, or CT angio

Call CEPOD

Question 3

Causes of acute limb ischaemia

Answer 3

Thrombus within lesion of atheroscleoris (60%)
-precipitated by dehydration, hypotension, malignancy, polycythaemia, inherited thrombotic states

Embolism (30%)

• Cardiac: AF, MI/ left vebtricular mural thrombus, ventricular aneurysm
• Dissection
• Aneurysm
• Trauma

Question 4

Scoring for critical limb ischaemia

Answer 4

WIFi

W: Wound

0: no wound
1: superifical
2: deep
3: deep and extensive, full-thickness heal

I: Ishcaemia
0:
1:
2:
3:

Fi: Foot infection
0: no infection
1:
2:
3: sepsis