Last Updated on February 24, 2019 by FRCEM Intermediate

Etiology

• Left atrial embolic thrombus from atrial fibrillation
• Mural thrombus after myocardial infarction,
• Thrombus or emboli from abnormal or prosthetic heart valves
• Emboli (thrombus or atherosclerotic) from an arterial aneurysm (aorta, femoral, or poplite)
• Proximal atheromatous stenosis
• Trauma
• Iatrogenic
• Intra-arterial drug use
• Compartment syndrome
• Crush injury

Clinical Features

• Pain
• Pallor
• Pulselessness
• Paresthesia
• Perishingly cold
• Paralysis

Incomplete arterial occlusion, extensive necrosis will occur within 6 hours

Investigation

• serum lactate
• Coagulation
• ECG.
• CT angiography

ED Management

• Analgesia e.g. IV morphine 2.5 — 10mg titrated to response
• Intravenous heparinisation (heparin 5000units IV bolus then heparin infusion) to prevent clot extension and promote distal re-perfusion
• Urgent referral to a vascular surgeon (to consider intra-arterial thrombolysis, angioplasty embolectomy or surgical bypass grafting)

Complications

• Compartment syndrome
• K+ ions causing hyperkalaemia
• H+ ions causing acidosis
• Myoglobin, resulting in significant AKI