MSFinals-6458

A 68-year-old man presents to the emergency department with increasing pain in his right leg. He has had intermittent claudication for a few months but has had a sudden increase in pain since this morning. His past medical history is otherwise significant for 2 previous myocardial infarctions, for which he takes regular simvastatin, aspirin, ramipril and atenolol.

On examination, his right dorsalis pedis and tibialis anterior pulses are weak, and his right leg is pale and cold below the knee.

His pain is currently being managed with oramorph.

What should be included in the initial management plan for this likely diagnosis?