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Aetiology

1. Embolus: commonest
2. Thrombosis: pre-existing stenosis, aneurysm or occlusion
3. Trauma

Presenting Features

1. Pale
2. Pain
3. Parasthesia
4. Pulseless
5. "Perishingly cold"
6. Paralysed

Management

1. History
   • Onset / duration
   • Risk factors: peripheral vascular disease, cardiac disease
2. Examination 
   • Cardiovascular exam
   • AAA
   • Examine limb - sensation, motor function, pulses; compare with contralateral limb
3. Investigations
   • Hand-held doppler flow
   • Arterial doppler
   • (If "threatened" - angiogram)
   • Determine source of embolus - cardiac (electrolytes, ECG, echo)
4. Treatment
   • Resuscitation - oxygen, IV fluids, analgesia
   • IV heparin - prevent thrombus propagation
   • Salvagable: embolectomy, bypass
   • Consider thrombolysis (with tPA - tissue plasminogen activator)
   • Unsalvagable: amputation
5. Post-operative
   • Continue anticoagulation (1) Heparin (2) Warfarin for 3 months
   • Continue resuscitaiton
   • Physiotherapy
   • Protect limb