Cannot miss / life threats
Cannot miss / life threats
Diagnostic flow โ check first
Diagnostic flow โ check first
- Unilateral thigh swelling โ Doppler.
- Pain out of proportion โ compartment / nec fasc / arterial.
- High-energy mechanism โ assess for femur shaft + blood loss.
- Burning anterolateral numbness โ meralgia paresthetica.
Differential diagnosis โ checklist
0/15
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
Vascular0/4
Soft-tissue / nerve0/5
Inflammatory / metabolic0/2
Initial ED workup
Bedside0/5
- Vitals
- Inspect for swelling, asymmetry, ecchymosis, color
- Palpate compartments, calf for cord
- NV exam, distal pulses
- Measure calf/thigh circumference
Labs0/3
- CBC, CRP, CK, lactate
- D-dimer if DVT/PE on table
- Type & screen if femur fracture
Imaging0/4
- XR for fracture
- Doppler US for DVT
- CTA for arterial occlusion
- MRI (with & without contrast) for soft-tissue/abscess/myositis
Initial management0/5
- Splint, elevate, analgesia
- Anticoagulate DVT
- Emergent fasciotomy for compartment
- Traction splint + blood products for femur fracture
- Surgery + abx for nec fasc / pyomyositis
Pearls / pitfalls
Pearls
- A femoral shaft fracture can lose >1 L blood โ check H&H and have blood ready.
- Statin myalgia can progress to rhabdo โ always check CK with dark urine.
- Phlegmasia is limb-threatening; treat aggressively with thrombolysis, not just heparin.