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There are >12 million patients with peripheral artery disease in the United States. The most severe form of peripheral artery disease is critical limb ischemia (CLI). The diagnosis and management of CLI is often challenging. Ethnic differences in comorbidities and presentation of CLI exist. Compared with white patients, black and Hispanic patients have higher prevalence rates of diabetes mellitus and chronic renal disease and are more likely to present with gangrene, whereas white patients are more likely to present with ulcers and rest pain. A thorough evaluation of limb perfusion is important in the diagnosis of CLI because it can not only enable timely diagnosis but also reduce unnecessary invasive procedures in patients with adequate blood flow or among those with other causes for ulcers, including venous, neuropathic, or pressure changes. This scientific statement discusses the current tests and technologies for noninvasive assessment of limb perfusion, including the ankle-brachial index, toe-brachial index, and other perfusion technologies. In addition, limitations of the current technologies along with opportunities for improvement, research, and reducing disparities in health care for patients with CLI are discussed.

This retrospective study examined the medical records of 100 patients who experienced an in-hospital cardiopulmonary arrest. The purposes of this study were to identify pre-arrest physiologic changes that may have occurred in the patient and to determine whether physician notification time, physiologic variables, patient location, and the presence of an electrocardiogram (ECG) monitor before the arrest affected the resuscitation outcome. The results showed that assessment variances were present in most patients before the arrest and also were recognized by the nursing staff. Implications for practice include formation of quality improvement screening tools to assess the patient's pre-arrest status, development of competency tests that include scenarios involving changes in a patient's physiologic parameters, staff education, and evaluation of current nursing policies for obtaining vital signs and assessments.

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