Chapter 9: Digits Plethysmography and pressures Flashcards

1
Q

digit plethysmography and pressures helps to

A

detect presence of arterial disease
differentiate fixed arterial obstruction from vasoplasm
asses effects of treament

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2
Q

limitations of digit plethysmography and pressures

A

quality of tracings effects by vasoconstriction from temperature (pt coming in from cold weather, cold room)
bandages that can’t be removed
ulcers
patient with tremor

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3
Q

with volume plethymography cuffs applied too tightly can

A

obliterate or diminish pulse waveforms

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4
Q

with photo plethysmography improper skin contact will cause

A

poor results

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5
Q

patient positioning for digit plethysmography and pressures

A

toe evaluation: supine with some elevation of head

finger evaluation: sitting with arms resting on pillow placed on patients lap

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6
Q

technique for toe plethysmography

A

pt kept as warm as possible
study done in combination with a complete LE arterial exam or limited ABI
cuff atleast 1.2 times the size of toe (2.5-3cm) applied to base of big toe

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7
Q

usual method for obtaining great toe pressures is

A

PPG

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8
Q

PPG great toe pressures method

A

cuff placed at base of great toe
photocell attached to plantar side of toe using tape or velcro
pulses recorded
paper speed slowed to 5mm/sec
cuff inflated 20-30 mmHg above highest brachial
cuff deflated waiting for return of first pule to define pressure level

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9
Q

Fingers without cold stress technique

A

complete UE arterial study
eval doppler signals and obtain pressures
doppler palmar arch to verify patency
apply finger cuffs (2-2.5cm)
pressures and waveforms obtained similar to toes

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10
Q

fingers with cold stress are preformed

A

in cases of symptoms occurring due to cold sensitivity

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11
Q

fingers with cold stress technique

A

after resting hands are immersed in cold water for 3 minutes

waveforms and pressures obtained following cold stress immediately after and then 5 minutes after

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12
Q

what should you document in fingers with cold stress technique

A

skin color

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13
Q

interpretation of digital plethysmography normal waveforms:

A

sharp upstroke during peak systole

prolonged down-stroke with notch (reflected wave) approximately halfway down

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14
Q

interpretation of digital plethysmography abnormal obstructive waveforms:

A

slow upslope
rounded peak
downslope bows away from baseline

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15
Q

occlusion located anywhere proximal to the tip of finger causes

A

pulses to assume obstructive form

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16
Q

abnormal peaked waveform qualities

A

upslope slower than normal
sharp anacrotic notch is present
reflected wave located high on the downslope
characteristics of normal and obstructive waveforms

17
Q

organic (fixed) obstructive disease has

A

abnormal doppler arterial signals, systolic pressures and PPG tracings

18
Q

Functional (intermittent) obstructive disease has

A

normal doppler arterial signals, systolic pressures and PPG tracings
has abnormal findings after cold stimulation

19
Q

sumner and strandness say peaked pulse is seen

A

with patients with raynauds

20
Q

UE digits normal finger/brachial indices

A

.8-.9

21
Q

Toe/brachial indices

A

vary from 60-80% if brachial pressure

22
Q

the presence of artificially high ankle pressures from arterial calcinosis usually

A

negates a toe/ankle P index

23
Q

the pressure index seen with digital artery occlusion is

A

severely reduced