Pulseless Extremity

Pulseless Extremity is a topic covered in the Pocket ICU Management.

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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

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Last updated: April 29, 2010