ARTERIAL Flashcards
Arterial Diff dx
Location- distal digits toes or fingers
Tissue- Dry, necrotic or slough, little or no granulation
Pain- Yes, may have dependent leg syndrome
Skin- Dry, hairless, shiny, thin
Exudate- none unless infected
Venous diff dx
Location- Lower 1/3 of leg gaiter area
Tissue- red pink, bark texture, yellow slough poor granulation
Pain- generally not unless vasculitic
Skin- hemosiderous (dark, browny appearance)
Exudate- Varies may have copious serous drainage
Pressure diff dx
Location- over bony prominences
Tissue- varies from dark to red to eschar
Pain- varies depending on structures involved
Skin- macerated, wet, erythematous
Exudate- varies
Neuropathic diff dx
Location- Weight bearing surface of foot or dorsal digits
Tissue- Callus or blister, slough, may probe to bone, necrotic with PAD
Pain- NO PAIN until infected deep throne
Skin- Dry, thick, scaly,
exudate- varies depending on infection
Critical Limb Ischemia
Reduction in distal tissue perfusion below resting metabolic requirements
Usually associated with atherosclerosis
1st Critical Phase
Initially, circulatory system compensates by forming collateral circulation around occlusions to maintain blood flow
1st critical phase
Collateral circulation is insufficient for needs of the extremity
The limited blood supply goes to the muscles vs. the skin
A wound formed in this phase may be slow to heal and is more likely to become infected
The non-healing wound may be the first indication of PAD
2nd Critical Phase
Occurs when activity causes relative ischemia and pain
Intermittent claudication – muscle pain/cramping w/ exercise
Pain w/ exercise may be the second indication that the pt has PAD
3rd Critical Phase
Sever Ischemia
- Resting pain
- Gangrene
- Non healing wounds in the extremity distal to the occlusion
- Dependent leg syndrome
Phases of PAD
-Phase 1: insufficient collateral circulation for metabolic needs
Delayed healing of wounds on distal extremity
-Phase 2: insufficient muscle perfusion with exercise
Intermittent claudication with exercise
-Phase 3: severe ischemia
Rest pain
Dependent leg syndrome
Distal digit ischemia
Diagnostic tests non-invasive
Pulses
Doppler Exam of pulses
Capillary Refill Time
Rubor of Dependency
ABI
Toe Pressures
Transcutaneous oxygen perfusion
Diagnostic test
Palpate pulses – compare to the contralateral limb
Confirm with hand-held Doppler
2 scales: A: Scale of 0 to 3+ 0: Absent 1+: Diminished pulse 2+: Normal pulse 3+: Pathologically prominent pulse (severe aortic insufficiency of aneurysm)
B: Scale 0 to 4+ 0: Absent 1+: Faint but detectable 2+: Diminished pulse 3+: Normal pulse 4+: Bounding pulse
Capillary Refill Time
- Estimation of microvascular disease
- Press the end of the toe or the skin just proximal to the wound until the color disappears and then measure time for return of original color
- Normal: <3 sec
- BUT this varies greatly
- Screening test to indicate if further test might be needed
Rubor of Dependency
- Screening for ischemia, not definitive for PAD
- Extremity is elevated and observed for pallor
- Foot is then returned to a dependent position
- Normal: color returns within 15 sec
- Severe ischemic disease: color takes 30 sec or more and is dark red vs healthy pink
Ankle Brachial index
Right ABI= Higher of the R ankle systolic pressures/Higher brachial systolic
Left ABI= Higher of the L ankle systolic pressures/ Higher brachial systolic
1-1.2- normal
.8-1.0: minimal peripheral arterial
.5-.8: moderate peripheral arterial disease, often with intermittent claudication;compression is contraindicated if
Segmental pressures
Give an initial indication of location of arterial occlusive lesions
May be falsely elevated in pts with calcified arteries
