Arterial embolism/thrombosis: The Daily PANCE Blueprint
A 72-year-old male with a history of atrial fibrillation presents with acute left lower extremity pain. On physical exam, the LLE is pale, pulseless, and cool to touch. What is the most likely diagnosis?
A. Deep venous thrombosis
B. Acute limb ischemia
C. Peripheral vascular disease
D. Compartment syndrome
E. Vasculitis
Answer and topic summary
The answer is B. Acute limb ischemia
Acute limb ischemia is an emergency. It basically occurs because the arterial blood supply to a limb is reduced. Etiologies include arterial thrombosis (e.g., PAD, stent thrombosis, vasculitis) or embolism (e.g., cardiac emboli from Afib, DVT) or trauma. Classically clinical features include the “6 Ps” – paresthesia, paralysis, poikilothermic, pulselessness, pallor, and pain. The lower limbs are more commonly impacted. The best initial test is arterial dopplers; a run-off CTA is ordered to confirm. Treatment for acute limb ischemic is IV heparin followed by revascularization (catheter-directed thrombolysis and/or percutaneous mechanical thromboembolectomy).
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
Also covered as part of the General Surgery EOR topic lists
