Assessing peripheral circulation
The six P's of acute arterial occlusion : pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (cold limb). A surgical emergency.. Arterial insufficiency : cool pale limb, hairless shiny skin, thick nails, weak or absent pulses, pain on walking relieved by rest, pain worse when the leg is elevated.. Venous insufficiency : warm edematous limb, brown discolouration, palpable pulses, heaviness relieved by elevation. Never elevate a limb with arterial insufficiency, and never apply compression to it.