General Surgery Rotation

Patient will present as → A 56-year-old man is seen in the ED for onset of severe pain and numbness in his left leg that began 30 min ago. He has a past medical history significant for hypertension, diabetes, and hyperlipidemia. Physical exam reveals a temperature of 98.3 °F, blood pressure of 134/74 mmHg, pulse of 89/min, and respiratory rate of 16/min. Heart is irregularly irregular with no murmurs appreciated. On extremity exam, there is absent pulses in the left femoral, popliteal, and pedal arteries. On the right, all pulses are 2+. The left foot is cool to touch as compared to the right. Sensation to pinprick is decreased on the left dorsum of the foot compared to the right.

Caused by a sudden arterial occlusion

• Remember the “six P’s” (You must know these!): Pain, Paralysis, Pallor, Paresthesia, Polar (some say Poikilothermia—you pick), and Pulselessness
• Atrial fibrillation and mitral stenosis are common causes of thrombus formation.
• Lower extremities are more common than upper extremities

Angiography is considered the gold standard for diagnosis

• ECG (looking for MI, AFib)
• Echocardiogram (+/- ) looking for clot, MI, valve vegetation

Anticoagulate with IV heparin (bolus followed by constant infusion)

• Surgical embolectomy via cutdown and Fogarty balloon (bypass is reserved for embolectomy failure)
• Postoperatively watch for compartment syndrome, hyperkalemia, renal failure from myoglobinuria, MI

Adapted from surgical recall, by Lorne Blackbourne