A 65 y/o M presents to the ED with a 1-day history of an extremely painful R lower extremity. There is no history of trauma. His past medical history includes hypertension and dyslipidemia, as well as a 30 pack-year smoking history. An ECG shows Atrial Fibrillation. He is not on any anticoagulation. On examination you find that the R lower leg is cool and pale. There is altered 2-point discrimination when compared with the other side, and you are unable to palpate a dorsalis pedal pulse. What is the BEST next step?

About the Author: Anton Helman

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.