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Question
A 60 year-old man with history of atrial fibrillation, CAD presents with left lower leg/foot pain for a few days. His foot is seen below. What's the diagnosis?
Answer
Mottling with concerns for Acute Limb Ischemia
Key Points:
- Assess appearance, temperature, sensation, strength and pulses
- Remember 6 P's (paresthesia, pain, pallor, pulselessness, poikilothermia, paralysis)
- Irreversible tissue necrosis can occur by 6 hours from onset
- Start IV Heparin bolus (100 units/kg or 5000u) and continuous IV infusion (1000 units/hr) with considerations for any contraindications
- Immediate vascular consult
References
Creager MA, Kaufman JA, Conte MS. Clinical practice. Acute limb ischemia. N Engl J Med. 2012;366(23):2198-206.
http://www.emdocs.net/acute-limb-ischemia-pearls-pitfalls/