The EM Educator Series: Pain out of proportion – “Please cut my leg off”

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!



A 53-year-old male presents with left lower leg pain and pallor. The pain worsened suddenly this morning. He has a history of atrial fibrillation, coronary artery disease, hypertension, and hyperlipidemia.



  • Which patients are at risk for an ischemic leg?
  • What etiologies should you consider?  Thrombosis, embolism, and what else?
  • What is the differential for patients with pain out of proportion to exam?
  • How do you diagnose an acute ischemic limb? What roles do ABI, US, and CT with IV contrast play in diagnosis?
  • What is the ED management, and who can assist you in the ED (IR, vascular surgery)?


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