80yo w sudden pain in R leg

It was like a sharp pain from my left knee downwards. My whole lower leg just hurt and was very sore to touch. I also noticed it was alot cooler than the other leg. It got worse over minutes and became really unbearable which was why i called the ambulance.

Hx
Longstanding AF but not on warfarin due to allergy (pruritic rash).
Known peripheral vascular disease w bilateral femoral grafts 2 years ago.

O/E
pain resolving spontaneously, but it is noted that pt had 5mg of morphine 2/24 prior.
pedal pulses strong and equal bilat.
both feet are equally warm.
both calves are symmetrical in size and non-tender.

Progress:
- A vascular registrar was consulted and an urgent doppler ultrasound was ordered which showed monophasic flow from the mid femur onwards.
- Is there need for an urgent embolectomy/angioplasty?



Consultant: No. It's likely this guy just had a transient embolic attack.


Learning Points:

• Atrial Fibrillation causes haemostasis and raises the risk of embolism. This guy was lucky it did not go to his brain! Hence the need for warfarin anticoagulation in AF patients.
• Always rule out the following in a unilateral painful limb:
• Compartment syndrome - PPPP's (pain pulseless parasthesias perishinglycold)
• DVT - painful calf assoc SOB
• Acute vascular compromise - check pulses/warmth/cap refill.