Cannot miss / life threats
Cannot miss / life threats
Diagnostic flow โ check first
Diagnostic flow โ check first
- Unilateral swelling โ Doppler.
- Pain out of proportion โ compartment / nec fasc / arterial.
- Calf swelling after Achilles 'pop' โ check Thompson.
- Foot drop โ peroneal palsy vs L5 radic.
Differential diagnosis โ checklist
0/17
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Traumatic0/4
Vascular0/5
Soft-tissue / nerve0/5
Other0/3
Initial ED workup
Bedside0/5
- Vitals
- Inspect for swelling, asymmetry, color, ulcers
- Palpate compartments, dorsalis pedis + posterior tibial pulses
- ABI bedside if any concern for arterial
- NV exam
Labs0/3
- CBC, CRP, CK
- D-dimer if DVT on table
- Lactate if sepsis
Imaging0/4
- XR for trauma
- Doppler US for DVT
- CTA for arterial / phlegmasia
- MRI (without contrast) for soft-tissue / stress fracture
Initial management0/5
- Splint, elevate, analgesia
- Anticoagulate DVT
- Fasciotomy for compartment
- Surgery + IV abx for nec fasc
- Heparin + vascular consult for arterial
Pearls / pitfalls
Pearls
- A 'ruptured Baker cyst' looks identical to DVT โ get the US.
- A thrombosed popliteal aneurysm presents like acute limb ischemia in older patients.
- All 4 compartments must be released in lower-leg fasciotomy.