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Anterior shoulder dislocation — RCPSC EM MCQ

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HardMusculoskeletalAnterior shoulder dislocationRCPSC EM

A patient with atrial fibrillation develops sudden painful pale left leg with absent pedal pulses, new toe numbness and reduced ankle movement. What is the most appropriate initial management?

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Correct answer: E — Give unfractionated heparin and call vascular surgery for a threatened limb

The best answer is “Give unfractionated heparin and call vascular surgery for a threatened limb”. This is threatened acute limb ischaemia with sensory and motor deficit. Unless contraindicated, initiate anticoagulation and urgently involve vascular surgery for revascularization planning and viability assessment. Observation, compression, outpatient pathways or indiscriminate thrombolysis risk irreversible limb loss and do not provide the required specialist decision-making.

Reference: Emergency Care BC: Acute Limb Ischemia: https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-limb-ischemia/