Last updated on 05 Jan 2023 at 3:20 PM (CVS07)

Acutely painful limb
A 65 year old Indian man is brought into the Emergency Department after waking up with severe pain in his right leg. He has never had this pain before. You are oncall with the vascular surgical registrar and go to see him. You find out that he has an 'irregular heartbeat' for which he takes aspirin.

 

Applied Science for Medicine
Arterial supply and venous drainage of the limbs
Flow dynamics, Starling's curve and principles of vascular resistance
Pathophysiology of cardioembolic disease and thrombocclusive peripheral vascular disease
Compartment syndrome and acute limb ischaemia
Pharmacology of aspirin, clopidogrel, statins, fibrates, ion-exchange resins, thiazide diuretics, ACE inhibitor, angiotensin 2 receptor antagonists, alpha-receptor blocker, unfractionated heparin, low molecular weight heparin, warfarin, fibrinolytics

Clinical and Communication Skills
History from a patient with acute limb ischaemia
Examination of the peripheral vascular system; recognise atrial fibrillation and acute arterial obstruction
Perform Buerger test
Differential diagnosis of acute painful limb
Interpret arterial Doppler, ankle:brachial pressure index, ECG
Indications for arterial duplex ultrasound, angiogram, MR venogram, MR angiogram
Management of acutely ischaemic limb, peripheral vascular disease, compartment syndrome and deep vein thrombosis
Indications for limb amputation
Prognosis of peripheral vascular disease
Rehabilitation post-amputation and role of the physiotherapist and occupational therapist; management of neuropathic pain

Personal and Professional Skills
Smoking cessation
Breaking bad news
Coping with new disability
Disposal of body parts

Population Health
Epidemiology of acute limb ischaemia
Epidemiology of peripheral vascular disease
Epidemiology of atrial fibrillation

 

Conditions to be considered relating to this scenario

Common

thromboembolic peripheral vascular disease, thrombo-occlusive peripheral vascular disease, deep vein thrombosis, spinal stenosis, sciatica, thrombophlebitis, osteoarthritis, septic arthritis, strain, sprain, trauma, ruptured Baker's cyst

Less common but 'important not to miss'

cholesterol emboli syndrome, compartment syndrome, necrotizing fasciitis, peripheral vascular trauma, popliteal aneurysm, abdominal aortic aneurysm, cauda equina syndrome

Uncommon

Buerger's disease