Ischemic limb
Posted by dkwinter

History

  • Prior vascular issues (CAD, stroke, prior ischemia)
  • Smoking
  • HTN
  • DL
  • DM
  • Atrial fibrillation

 

Presentation

  • Painful leg
  • Cold leg
  • Weak leg
  • Frequent falls

 

Labs

  • CBC
  • CRP
  • Renal function
  • Coagulation studies (PT/PTT)
  • EKG (r/o PAF)

 

PE

  • Pulses (check bilaterally), if lower extremity:
    • Femoral
    • Popliteal
    • PT
    • DP
  • Skin
    • Cap refill
    • Temperature
    • Presence of mottling
    • Sensation
      • Light touch
      • Pain
  • Strength
    • Hip flex/ex
    • Knee flex/ex
    • Ankle flex/ex
    • Toes flex/ex

 

Consults

  • If rural general surgeon available, have them provide input of viability of limb (vascular surgeon will appreciate it)
  • Vascular surgeon

 

Imaging

  • CTA abd/pelvis with femoral runoff
    • Required regardless of renal function
      • Possible exception of circumstance of non-viabile limb/futile intervention or decision for palliative care

 

Intervention

  • Heparin (DVT protocol)
  • Revascularization