Chapter 9- Segmental Pressures

Question 1

If there is a pressure drop between the CFA and the Femoral Artery, what can be suspected?

Answer 1

flow limiting stenosis.

Question 2

Is the systolic ankle pressure usually greater than or less than the brachial pressure?

Answer 2

the ankle systolic pressure is GREATER THAN OR EQUAL to the brachial pressure.

Question 3

When a patient is in a cold room, what can this do to his vessels size wise?

Answer 3

Vasoconstriction

Question 4

If you have a diabetic patient with calcified vessels, how can this affect our segmental pressures?

Answer 4

it can create falsely elevated pressures.

Question 5

Ideally the cuff should be placed over the artery so inflation quickly transmits the pressue to the tissue to compress the artery

Answer 5

True

Question 6

There are two types of ways to get segmental pressures. What are they?

Answer 6

Three cuff method and 4 cuff method

Question 7

For the 4 cuff method, where would you put the cuffs?

Answer 7

Bilateral brachials

2 thigh cuffs (one high one distal thigh)

below the knee (upper calf)

and ankle.

Question 8

For the 3 cuff method, where would you put the cuffs?

Answer 8

Bilateral brachials

1 thigh cuff (big one)

Below knee (upper calf)

and ankle.

Question 9

What is the 20% rule???

Answer 9

Width of cuff 20% greater than the diameter of the limb.

**should be a 30 mmhg difference not the usual 20-25

If you use too small of a cuff, it can make high pressure.

Question 10

What is a positive of using 4 cuffs versus 3?

Answer 10

Determine more whether something is proximal or distal versus, just in the calf or just in the thigh.

Question 11

Why does the 4 cuff method “Violate” the 20% rule?

Answer 11

it will result in artifactually higher/elevated thigh pressures. They will be around 30 mm / hg higher.

Remember that when determining if there is disease.

Question 12

When doing your segmentals (ABI), do both the dorsal/anterior tibials and the posterior tibials. How do you know which vessel to use to compare to all other measurements?

Answer 12

use the highest pressure to compare.

Question 13

In what order should you do your segmentals so that there is no vasodilation affecting the pressures?

Answer 13

work from distal to proximal (work backwards essentially). So do the brachials, then ankles, then move up towards the thigh. If you did the thigh first it may affect everything distal to that.

Question 14

REMEMBER!

You want to wait until complete cessation of blood flow (until you don’t hear any more flow). Then inflate the cuff ___ above the last noise.

Answer 14

20-30 mmhg

Question 15

How do you calculate the ABI ( ankle brachial index?)

Answer 15

Divide the highest ankle pressure by the high brachial pressure.

Question 16

An ABI of > 1.0 is considered normal or abnormal?

Answer 16

normal

Question 17

An ankle brachial of 0.9 indicates what?

Answer 17

probably abnormal

Question 18

An ABI of <0.8 indicates what?

Answer 18

claudication ( single level disease)

Question 19

An ABI of 0.5 usually indicates what?

Answer 19

multi-level disease or long segment occlusion

Question 20

An ABI of 0.3 indicates what?

Answer 20

Ischemic rest pain

Question 21

If you see an ABI of greater than 1.3 , what would you first think?

Answer 21

medial calcification in a diabetic person.

Question 22

a 20-30 mmhg difference in blood pressure in a lower leg is considered abnormal or normal?

Answer 22

abnormal

Question 23

a 15-20 mmhg different between the radial and ulnar blood pressure is normal or abnormal?

Answer 23

abnormal.

Question 24

If there is a toe pressure less than 30 mmhg, there is a good chance of the toe healing

Answer 24

NO incorrect.

Usually if its less than that it will have poor healing potential.