Cold Painful Limb

First actions / assessment

• Assess ABCDE first and do not miss shock, sepsis, or major trauma. Clarify exact onset, whether symptoms were sudden or progressive, location, severity of pain, prior claudication/rest pain, previous vascular procedures, atrial fibrillation, recent MI, known aneurysm, thrombophilia, smoking, diabetes, anticoagulant use, trauma, and neurological symptoms. Examine both limbs side by side for colour, temperature, capillary refill, pulses at all levels, Doppler signals if available, sensation, motor function, compartment firmness, tissue loss, and signs of chronic PAD. The classic acute limb ischaemia features are the 6 Ps: pain, pallor, pulselessness, perishingly cold, paraesthesia, and paralysis, though early presentations may show only pain, pallor, and pulse deficit. Check ECG for AF and do baseline bloods including CBC, U&E, coagulation, lactate, CK, group and save/crossmatch if severe. If acute limb ischaemia is suspected, obtain urgent vascular input and CTA if feasible and it will not delay definitive management.