VASCULAR EMERGENCIES · MEMBERSHIP SURGERY

Acute limb ischaemia — 68M smoker, cold pulseless leg

12 decision points ~24 min Difficulty 4/5 Membership

Setting

You are the on-call surgical registrar at Korle Bu. Vascular ultrasound is bedside-available; CT-angiography runs on-call; interventional radiology needs 2 hours to activate; theatre and anaesthesia are on standby.

Patient

Mr O, a 68-year-old retired policeman and 40-pack-year smoker, presents 4 hours after sudden onset of a cold painful right leg while watching football. He is known hypertensive on amlodipine, in atrial fibrillation for 5 years off warfarin. His right foot is white, cold, insensate to touch below the ankle, with reduced motor power in dorsiflexion. Right femoral pulse present; popliteal, DP and PT absent.

Reference stack

Bailey & Love 28e Ch 57 · Sabiston 21e Ch 63 · Rutherford 1997 classification · ESVS 2020 acute limb ischaemia · TASC II 2007 · STILE 1994 · TOPAS 1998

Start cascade →

You'll be asked to decide what happens next at each step. There's no timer — take your time. The correct answer + evidence-anchored rationale is revealed after each choice.