the acutely painful limb

Question 1

if an acutely painful limb is cold and pale, what should it be considered to be?

Answer 1

treat as acute limb ischaemia until proven otherwise

a surgical emergency. irreversible tissue damage occurs within 6 hours.

Question 2

what are the signs and symptoms of acute limb ischaemia?

Answer 2

the 6 Ps

• pain
• pallor
• pulselessness
• parasthesia
• perishingly cold
• paralysis

Question 3

what risk factors can put a patient at risk of acute limb ischaemia?

Answer 3

• AF
• hypertension
• smoking
• DM
• recent MI

Question 4

what investigation should be done if acute dumb ischaemia is suspected?

Answer 4

CT angiogram should be arranged if feasible for confirmation and anatomical delineation, along with urgent vascular review

Question 5

how is acute limb ischaemia treated?

Answer 5

a surgical emergency as irreversible tissue damage occurs within six hours; patients should be sufficiently resuscitated and started on IV heparin whilst decisions for definitive versus conservative treatment are made.

Question 6

what does an acutely hot and swollen limb suggest?

Answer 6

need to asses for DVT

pain is often localised to the calf and associated with calf tenderness or firmness

Question 7

what is used to calculate the probability of DVT?

Answer 7

well’s score

if score is >1 or =1 then need a ultrasound doppler scan, otherwise can be excluded with D dimer

Question 8

how is a DVT treated?

Answer 8

Therapeutic doses of LMWH

long term anticoagulation

those with illiofemoral DVT with severe symptoms require urgent vascular review

Question 9

how can trauma cause an acutey painful limb?

Answer 9

many injuries may go unreported with vague histories (especially in elderly patients or safeguarding cases).

If a fracture is suspected, check for focal bony tenderness and inability to weight-bear, and have a low-threshold for radiological imaging.

Question 10

what are the neurological causes of an acutely painful limb?

Answer 10

• neurological pathology
• radiculopathies, usually back pain that radiates to the affected area and is worse on movement, as well as potential muscle weakness, paraesthesia and altered reflexes
• central causes e.g Multiple sclerosis
• spinal e.g disk herniation
• peripheral e.g infective or traumatic causes

Question 11

what investigations should be done into a acutely painful limb and how should they be treated?

Answer 11

• ABCDE approach
• haemodynamically stabilised
• document NV status
• CT angiography if deemed treatable in acute limb ischaemia
• treatment is disease specific
• routine bloods including group and save
• analgesia

Question 12

In a patient presenting with an acutely swollen limb up to the thigh, what is the most likely diagnosis?

Answer 12

Iliofemoral DVT

Question 13

which examinations are imperative when assessing the acutely painful limb?

Answer 13

Cardiac and peripheral Vascular

Neurological

Musculoskeletal