Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, severe ischemic rest pain in the [Left/Right/Bilateral] lower extremity, exacerbated by elevation and relieved by dependency. Symptoms persistent for >2 weeks. Associated with non-healing ulceration/gangrene of the [distal digits/heel/dorsum of foot]. History significant for tobacco use, HTN, DM, and hyperlipidemia. Denies claudication, reports constant nocturnal pain requiring analgesia.
Clinical Examination Findings
Vitals: Stable. Vascular Exam: [Left/Right] lower extremity shows dependent rubor, pallor on elevation, and capillary refill time >3 seconds. Pulses: Femoral [+2], Popliteal [0/diminished], Dorsalis Pedis [0], Posterior Tibial [0]. Skin: Thin, shiny, hairless, cool to touch. Ulceration: [Location] with [necrotic/sloughy] base, measuring [X] cm, no surrounding cellulitis. ABI: [Value] (suggestive of severe arterial insufficiency).
Treatment Protocol
1. Antiplatelet therapy: Aspirin 81mg or Clopidogrel 75mg daily. 2. Statin therapy: High-intensity (Atorvastatin 80mg). 3. Glycemic control optimization. 4. Smoking cessation counseling. 5. Wound care: Offloading, moist dressing, and debridement as indicated. 6. Urgent vascular surgery/interventional radiology referral for revascularization (angioplasty/stenting or bypass). 7. Pain management: Titrated analgesia.