I can’t feel a pulse! Why not look for it instead?

I love to watch colleagues carefully palpate for pulses and try to listen for bruits, use doptones, etc. all the while desperately hoping they are not dealing with a completely ischemic limb.

Then I grab my ultrasound machine and throw some colour doppler on the subject and get a much better picture of what’s going on.  Sure there are subtleties to blood flow analysis using spectral wave forms, augmentation, and so on but for the simple-minded ER doc, if you see lots of colour on the good side and no colour on the bad side, you are probably onto the correct diagnosis and can move on to confirmatory studies or consultation very quickly. [ed.]

Here is another case from Dr. Lloyd Gordon:

This patient had a subacute (worsening) history of R foot pain. The foot was dusky and cool with a purplish spot. The coolness started mid-calf. Arterial POCUS revealed normal femoral, popliteal and calf vessels until about mid calf below which there was no doppler flow. There were no DP pulses either side. The left side was normal.

The posterior tibialis showed no flow on the Right. An elective U/S and CTA revealed arterial blockage mid-calf.