Problem Based Learning/Limb Ischemia/ Case scenario triggers To know the answers watch the following video in YouTube https://www.youtube.com/watch?v=WfxHIaeZgnc&t=2364s

1. LIMB ISCHEMIA
CLINICAL VIGNETTES-CASE
TRIGGERS
Dr. B. Selvaraj MS; Mch; FICS;
Professor of Surgery
Melaka Manipal Medical College
Melaka 75150 Malaysia

2. LEARNING OUTCOMES
ANY CLINICAL TEACHING

3. LIMB ISCHEMIA
DIAGNOSTIC ALGORITHM

4. LIMB ISCHEMIA
CHRONIC ISCHEMIA-
MINDMAP

5. CHRONIC LIMB ISCHEMIA
TREATMENT ALGORITHIM

6. ACUTE LIMB ISCHEMIA
MINDMAP

7. ACUTE LIMB ISCHEMIA
TREATMENT ALGORITHIM

8. CASE NO: 1: “Lifestyle-Limiting Claudication”
A 54-year-old male presents to the vascular surgery clinic with 6 months history of right calf pain with
ambulation. The pain consistently occurs after walking about 150 feet and is remitted with rest. Despite the
pain, he is able to perform his duties and carry out normal activities of daily living. He has a history of
hypertension for which he is on hydrochlorothiazide and has been smoking one pack of cigarettes per day
since age 18.
O/E: Palpable femoral pulses bilaterally and absent popliteal and pedal pulses on the right side
W/U: On the right, the ABPI was diminished at 0.68
A. What is your diagnosis and
why you are saying so?
B. What other questions you will
ask in history?
C. What are the risk factors?
D. What is the pathophysiology
of this condition?
E. What is the clinical test
performed in Fig 1 ?
F. What are the investigations
performed in Fig 2 and Fig 3?
G. How will you treat this case?

9. CASE NO: 2: “Limb threatening ischemia”
A 47-year-old man a known case of HTN,DM, tobacco abuse and CAD, presents to the ER with a 3-week
history of spontaneous ulceration of the left great toe and increasing rest pain in the left foot. Vital signs
are normal.
O/E: Dry gangrene at the base of the left great toe with mild surrounding cellulitis. The patient has dry
and hairless skin of the bilateral lower extremities. Bilateral femoral and popliteal pulses are palpable.
Pedal pulses are absent to palpation, but there is an audible Doppler signal at the left dorsalis pedis.
There is no sensory and motor loss
A. What is your diagnosis and
why you are saying so?
B. What you are seeing in Fig 1?
D. What investigation is done in
Fig 3?
E. What are the surgical
interventions done in Fig 4 and
Fig 5?

10. CASE NO: 3: “Acute Limb Ischemia”
A 68-year-old active man presents to the emergency room (ER) with a 4-hour history of left limb pain
and numbness. He had fallen out of bed and noticed worsening limb symptoms ever since. He notes no
prior leg problems and no history of claudication, walking at least 2 KMs daily without stopping.
His past history is significant for a myocardial infarction 7 years ago and subsequent CABG. Past
medical history includes tobacco use and hypertension, but no diabetes or stroke. Medications include an
aspirin, a calcium channel blocker, and a statin agent. Now has a difficult time moving his foot due to
pain and neurologic impairment.
A. What is your diagnosis and
why you are saying so?
B. What are you seeing in Fig1
and Fig2?
C. What are all the clinical signs
you can elicit in this patient?
D. What investigation you will do
to confirm your diagnosis?
E. How will you treat this
condition depending on it’s
grading?
F. What are reperfusion injuries
and how will you manage them?

11. THANK
YOU
To know the answers to the above scenarios
watch the video in the link
https://www.youtube.com/watch?v=WfxHIae
Zgnc&t=2364s