Acute limb ischaemia

Last Updated on by frcemuser


  • 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


  • 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)



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

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