What are the recommended treatment options for acute limb ischaemia in a primary care setting before specialist intervention?

Recommended treatment options for acute limb ischaemia in a primary care setting before specialist intervention include:

• Immediate referral: Acute limb ischaemia is a vascular emergency requiring urgent assessment by a vascular multidisciplinary team; primary care should arrange immediate referral to specialist vascular services for assessment and management ¹.
• Initial assessment: In primary care, assess the limb for signs of ischaemia such as pain, pallor, pulselessness, paraesthesia, paralysis, and poikilothermia, and document findings including pulses and ankle brachial pressure index if possible ¹.
• Supportive care: Keep the affected limb warm and in a dependent position to promote perfusion; avoid applying direct heat or cold ¹.
• Analgesia: Provide pain relief with paracetamol and consider opioids depending on pain severity while awaiting specialist care ¹.
• Anticoagulation: Initiate systemic anticoagulation with intravenous or subcutaneous heparin as soon as possible to prevent thrombus propagation, if this can be safely administered in primary care and local protocols allow; otherwise, this should be started in hospital ¹.
• Avoid interventions: Do not attempt revascularisation, angioplasty, stenting, or major amputation in primary care; these decisions require specialist vascular input ¹.

These steps aim to stabilise the patient and limb while expediting specialist vascular assessment and intervention ¹.