Question of the Day... Critical Limb Ischaemia

This question is taken from the May Edinburgh 2013 Exam.

Question:
What are the diagnostic criteria for critical limb ischaemia?

Answer:
There are 3 main criteria for critical limb ischaemia.

1. Rest pain
2. Tissue loss
3. Ankle pressure of <50mmHg, ABPI <0.4, or Toe pressure of <30mmHg

Critical limb ischaemia is where the occlusion is no longer acute and the viability of the limb is threatened, requiring immediate management.

It is classically described with the 6 Ps:

Paraesthesia

Pain

Pallor

Pulselessness

Paralysed

Perishingly cold

Management of Critical Limb Ischaemia

In MRCS, the thing that you must remember is everything comes back to 1st principles. So when asked about management, first you talk about confirming the diagnosis (i.e investigations) then you talk about treatment. When talking about treatment, always start with A, B, and C.

A: Airway - intact

B: Ensure Oxygen is given

C: Ensure aggressive fluid resuscitation to avoid Reperfusion Syndrome. Place the patient on cardiac monitoring and monitor Urea and Electrolytes regularly. Consider doing an ABG and Lactate to further monitor acidosis and ischaemia

Management of CLI

In a nutshell!