رجل عمره ٧١ سنة عنده رجفان أذيني ولا يأخذ مميعاً، ومعروف بمرض شرايين طرفية. فجأة صارت رجله اليمنى باردة وشاحبة ومؤلمة جداً منذ ساعة، ولا يستطيع تحريك أصابعه، والنبض في القدم غير محسوس. ما التصرف الأنسب؟

A 71-year-old man with atrial fibrillation not on anticoagulation and known peripheral arterial disease has had a suddenly cold, pale, very painful right leg for an hour. He cannot move his toes and foot pulses are absent. What is the most appropriate action?

1. Give analgesia and reassess in 4 hours
2. Notify the physician now: this is acute arterial occlusion
3. Raise the leg on two pillows and apply warm packs to improve flow
4. Encourage walking to improve circulation

Answer: B) Notify the physician now: this is acute arterial occlusion. The six Ps (pain, pallor, pulselessness, paraesthesia, paralysis, poikilothermia) mean acute ischaemia, and hours of delay can cost the limb. Keep the leg level or dependent and do not apply direct heat.