Pulseless Extremity

First Things First (assess & treat for the following)

• Is extremity irreversible, threatened or viable?
  • Irreversible
    • Cyanotic/blue
    • Absent capillary refill
    • Mottled/marbled
    • Anesthesia/insensate
    • No motor function
    • No arterial or venous Doppler signals in foot
  • Threatened: treat w/ sense of urgency
    • Waxy/white color
    • Slow capillary refill
    • Moderate to severe pain
    • Mildly decreased sensory & motor function
    • Absent arterial Doppler signals in foot
    • Venous Doppler signals present in foot
  • Viable
    • Pale/pallor
    • Normal or mildly slowed capillary refill
    • Cool
    • Minimal or no pain
    • Normal sensory & motor function
• Is there a palpable pulse or Doppler signal or absent Doppler signals?
  • Palpate pulses in the dorsalis pedis (mid-dorsal foot) & posterior tibial (posterior to medial malleolus) positions.
  • If nonpalpable, interrogate for Doppler signals w/ a continuous wave Doppler.
• Definitions
  • Claudication: pain, usually in the calf or calves w/ exertion (subsides w/ rest)
  • Rest pain: pain at rest, usually at night & usually over the metatarsal heads or distal foot
  • Tissue loss/gangrene: usually develops in the distal watershed areas or in the immediate site of traumatic injury