Vascular: The Acutely Painful Leg

Question 1

How can an acutely painful leg present?

Answer 1

Cold and pale

Hot and swollen

Traumatic

Neurological

Question 2

How should a cold pale leg be managed?

Answer 2

Treated as acute limb ischemia, 6 P’s, examine contralateral leg, identify risk factors, CT angiogram, surgical emergency

Question 3

How should a hot and swollen leg be managed?

Answer 3

Assessment for DVT, pain often localised to calf, FH, recent immobility/surgery, wells’ score to be calculated, US doppler, LMWH before long-term anti-coag, Abx

Question 4

How should a traumatic acutely painful leg be managed

Answer 4

If fracture suspected check for bony tenderness and inability to weight bear, imaging

Question 5

How should a neurological acutely painful leg be managed

Answer 5

Radiculopathies will typically be associated with back pain that radiates to affected region and is worse on movement

Question 6

What investigations should be performed for an acutely painful leg

Answer 6

Detailed accurate Hx

Full vascular exam

Full neurological exam

Evaluation of NV status

CT angiogram

Bloods = routine, group and save

Question 7

What are the first steps in managing an acutely painful leg

Answer 7

Haemodynamically stabilised early as necessary

Early involvement of vascular surgeons

Analgesia