# Acute Limb Ischemia
-- ABCs: consult surgery or vascular surgery immediately if any c/f ischemia (threatened limb) or compartment syndrome
-- Chart Check: prior echos, LE procedures, AC use
-- HPI Intake: timing, pain, poikilothermia, pallor, paresthesia, paralysis; h/o AFib, prior clotting,
-- Can't Miss: threatened and non-viable limbs that require surgical attention; compartment syndrome
-- Admission Orders: CBC, BMP, coags, T+S, lactate, CTA with runoff, consider echo if c/f AFib or LV thrombus
-- Initial Treatment to Consider: heparin
-- History: *** PAD, stents, AF, atherosclerosis, hypercoagulability - APS, HITT, malignancy
-- Clinical/Exam: *** irregular rhythm, pulses, cap refill, ulcers decreased hair growth, dopplers, 5 P’s - pain, poikilothermia, pallor, paresthesia, paralysis
-- Data: *** coags, creatinine, lactate; EKG, CTA with runoff
-- Etiology/DDx: *** embolic >> thrombotic; dissection, proximal aneurysm, compartment syndrome
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- f/u CBC, BMP, coags, type and screen, lactate
-- f/u CTA if limb is viable or threatened
-- f/u echo if c/f cardiac thrombus
-- Serial doppler exams
-- if revascularization procedure - monitor for reperfusion injury - acidosis, hyperK, myoglobinemia, ATN, compartment syndrome
-- IV heparin drip titrated to PTT 60-80; f/u PTT q6-8 hours
-- f/u vascular surgery recs re: revascularization (catheter-directed thrombolysis vs thromboembolectomy) or amputation
PDF coming soon!
Acute limb ischemia mostly presents in the lower extremities and is more likely caused by an embolism vs thrombosis, as emboli acutely occlude vessels that have not had time to form collaterals. If you suspect limb ischemia based on the 5 P's (pain, pallor, pulses, paralysis, poikilothermia), get dopplers ASAP and call vascular surgery. Depending on how threatened the limb is, a CTA with runoff is usually needed for planning and appeciating collateral circulation. While treatment if often surgical to relieve obstruction, heparin will prevent further clot from propagating.