Authors: Simon Odum / Editor: Jason M Kendall / Reviewer: Phil Delbridge / Codes: CC7, NeuP6, NeuP8, SLO1, SLO2, SLO3, SLO7, SLO8, VC1, VC2Published: 18/12/2020

A 65-year-old male presents to the emergency department (ED) by ambulance with an episode of collapse. He states that he was walking on level ground when his legs became “weak and heavy”. He was unable to walk any further and collapsed to the ground. There was no leg, abdominal, chest or head pain at any time. Shortly after collapsing to the ground he became very short of breath, pale and clammy. On arrival to the ED, he also complains of parasthaesia and numbness in his feet.

He is normally fit and healthy and takes no medication. He stopped smoking 2 years previously. There is no family history of significance.

On examination, he is apyrexial, but appears cold and clammy. His pulse is 80 and regular, his blood pressure is 100/60 and heart sounds are normal. Respiratory examination reveals oxygen saturation of 94% in room air, respiratory rate of 25 and widespread bilateral crepitations. Supplemental oxygen is commenced. Abdominal examination reveals no tenderness, no palpable masses and there are normal bowel sounds present. Neurological examination reveals a mild bilateral leg weakness. There are no femoral pulses present and both feet are cold, white and pulseless (confirmed with Dopplers).