A fictional 72-year-old with atrial fibrillation develops sudden severe leg pain; the leg is cold and pale with reduced toe sensation.
Frame the danger first.
- Sudden pain, pallor, pulselessness, paraesthesia, paralysis and coldness suggest acute limb ischaemia.
- Motor deficit or profound sensory loss may indicate an immediately threatened limb.
- Use Doppler findings alongside a documented neurovascular examination; do not rely on pulse palpation alone.
Act, escalate, reassess.
- Give analgesia, assess ABCDE and contact vascular surgery urgently.
- Document motor power, sensation, temperature, capillary refill and Doppler signals serially.
- Use the local vascular pathway for anticoagulation, imaging and transfer decisions.
- Do not allow imaging logistics to delay surgical discussion when the limb may be immediately threatened.
Red flags that change pace.
- New weakness or paralysis, profound sensory loss or rapidly spreading numbness
- Absent arterial Doppler signal with a threatened limb
- Shock, severe pain out of proportion or signs of systemic embolism
What makes care less safe.
- Elevating or compressing an ischaemic limb
- Waiting for routine imaging before contacting vascular surgery
- Recording pulses without a motor and sensory examination
Say the concern plainly.
Possible acute limb ischaemia: onset [time], limb findings [pain/colour/temperature], motor and sensory status [summary], Doppler [result] and vascular plan [status].