Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Acute Foot Discoloration in a Patient With Peripheral Vascular Disease
Case Study
A rapid response event was initiated by the bedside nurse after the patient had symptoms of sudden pain in his left foot. Prior to calling the condition, the nurse assessed the patient’s pulse in the affected foot, and she did not feel it. On prompt arrival of the rapid response team, a quick chart review suggested that the patient was a 55-year-old male with a known history of persistent atrial fibrillation and peripheral vascular disease. He was admitted earlier for a traumatic left lower extremity injury at the job when a cement block fell on his extremity. The nurse had responded initially to the patient’s screaming and yelling that this was the worst pain he had ever felt and called the rapid response code after she was unable to locate patient’s dorsalis pedis or posterior tibial pulse. Patient also described pins and needles in his foot.
Vital Signs
-
Temperature: 99 °F, axillary
-
Blood Pressure: 170/95 mmHg
-
Pulse Rate: 125 beats per min (bpm) – irregular rhythm
-
Respiratory Rate: 22 breaths per min
-
Pulse Oximetry: 97% saturation on room air
Focused Physical Examination
A quick exam showed a middle-aged male in severe distress. His left foot had a shiny appearance with a bluish coloration, and the foot was cool to the touch. Pulses were checked and were not palpable at the dorsalis pedis and posterior tibial level on the affected side; these pulses were inaudible on bedside Doppler ultrasound as well. Pulses were present and 1+ in the femoral arteries bilaterally. Muscle strength and neurologic examination were difficult to be assessed in the left foot because of pain but were diminished compared to the right.
Interventions
The patient was given 4 mg intravenous (IV) morphine for pain. A dose of 5 mg IV metoprolol was given with improvement in his heart rate. Stat consult was called to vascular surgery for evaluation. IV unfractionated heparin was started, and stat arterial Doppler of lower extremities were ordered. The patient was transferred to the vascular surgery service for evaluation for revascularization vs. open embolectomy.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here