Question

Wayne a 67 year old man, presented to the emergency department with the following symtoms: cold extremity of tge right foot and ankle,complaining of severe pain, pale righty foot and ankle, and no pedal pulse of the right foot and ankle.

1. what is the preliminary diagnosis?

2.what diagnostic examination(s) wil be done?

3. will surgiacl intervention be necessary?

question # 46

what types of precaution shoud be taken when placing an IVC filter such as greenfield or venal caval clip?

Answer 1

ANSWER:-

PART (1) A 67 year old man with symptoms of cold extremity of the right foot and ankle and severe pain, pale right foot and ankle, and no pedal pulse of the right foot and ankle is suggestive of low blood flow to right extremity hence my preliminary diagnosis will be PERIPHERAL ARTERIAL DISEASE.

• In PERIPHERAL ARTERIAL DISEASE there is restriction of blood flow in arteries of leg and feet due to cholesterol plaques or other material on the walls of arteries.

Due to blocked circulation in right leg the blood flow is limited in right ankle and foot which has caused above symptoms.

Risk factors of PERIPHERAL ARTERIAL DISEASE are as follows:

1. Over the age of 50 years.

2. Chronic smoker.

3. Diabetes.

4. Hypertension (High blood pressure).

5. High blood cholesterol levels.

6. Sedantary life style.

7. Family history or personal history of heart stroke.

Part (2)

The diagnostic lower extremity examination that will be done are stated below:

1. Pedal pulse of right ankle and foot (Absent or low pulse is suggestive of Peripheral arterial disease).

2. Skin temperature of right ankle and foot (Cold temperature is suggestive of Peripheral Arterial Disease).

3. Skin discoloration ( Pale color of feet is suggestive of low blood flow to feet hence peripheral arterial disease).

(4) Ankle-Brachial index test. In this test, the blood pressure at arm and ankle are measured separately and then compared. An abnormal ABI is indicator of Peripheral Arterial Disease.

Part (3)

Since this patient presented with intense symptoms of total absence of pedal pulse with pale and cold feet and severe pain which means blood flow to the right ankle and feet in this patient is totally compromised, hence SURGICAL INTERVENTION is needed in him. An endovascular incision will be made or open leg bypass surgery will be done to improve the circulation of the leg and feet.