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cardio pulm exam 2 > clinical corell PAD > Flashcards

clinical corell PAD Flashcards

1
Q

signs and symptoms of peripheral arterial disease (PAD

A

HPI:
Claudication
Cramping and pain in legs with walking a certain distance
Diabetics may have leg fatigue instead of pain
Rest pain
Cramping in legs with elevated, relieved with dependent position
“black” ulcers or toes
Chronic ulcers that don’t heal
Painful ulcer despite neuropathy

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2
Q

signs and symptoms of peripheral arterial disease (PAD

A

HPI:
Claudication
Cramping and pain in legs with walking a certain distance
Diabetics may have leg fatigue instead of pain
Rest pain
Cramping in legs with elevated, relieved with dependent position
“black” ulcers or toes
Chronic ulcers that don’t heal
Painful ulcer despite neuropathy

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3
Q

treatment options for PAD

A 
Antiplatelet therapy
Aspirin or Clopidogrel (Plavix)
LDL cholesterol level of less than 100 mg/dL
HgA1c of less than 7%
Control of Hypertension
Possibly with benefit of ACE inhibitor
Tobacco cessation
embelectomy
angioplasty (baloon)
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4
Q

Risk factors PHD of PMH

A 
Diabetes
Coronary Artery Disease
Hypertension
Hyperlipidemia
Obesity
Aortic aneurism
Age
Race
Hispanic 
African American
Male gender
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5
Q

Metabolic risk factors diabeties

A

Hyperinsulinemia or hyperglycemia (2 hour PP after 100 gm oral dose > 200)
Hypertriglyceridemia (> 150) and low HDL (130/85)
Obesity: waist line > 40 inches in males, > 35 inches in females (waist alone will diagnose 80% of patients with metabolic syndrome)
Every increase of 1% of HgA1c, risk factor for PAD goes up 28%

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6
Q

PAD risk facotrs continued…PSH, SH, FH, ROS

A

PSH
Coronary artery stent placement or lower extremity stent placement
SH
Tobacco use
FH
Any family with history of risk factors or PAD
ROS
Same as HPI, may have someone coming in for other complaints and pick up PAD in this area

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7
Q

2 greatest risk factors for PAD

A

diabeites and smoking!!

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8
Q

PE derm

A 
Skin thin, atrophic
Lack of pedal hair
Brittle rigid nails
Cold 
Hemosiderin deposits
May have waxy appearance
Ulcers
Gangrenous
Granular with a lot of fibrotic tissue
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9
Q

Where palpate pulse during PE?

A

Palpate dorsalis pedis (tween 1st n second metatarsals) and posterior tibial (just behind medial maleoulus) pulses
If not palpable
may palpate popliteal and/or femoral pulses
Doppler DP, PT and perforating peroneal

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10
Q

Cap refill time

A

May be greater than 3 seconds (push on end of toe wont be able to see through the nail)

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11
Q

Dependent rubor

A

Foot looks red when dependent, pale with elevation

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12
Q

Doppler

Triphasic

A

normal

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13
Q

Doppler biphasic

A

mild to moderate PAD

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14
Q

Doppler monophasic

A

Severe PAD

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15
Q

ABI normal

A

.9-1.3

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16
Q

PAD with intermitent claudication

A

.5-.9

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17
Q
A

severe limb ischemia, rest pain n ulceration

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18
Q

Guidelines for Obstruction

segmental pressures

A

20-30mmHg difference between adjacent cuffs
30 mmHg change along leg from thigh to ankle
20mmHg or more difference between opposite leg, same level

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19
Q

Wagners index

A 
Ischemic Index = leg pressure/
	        		arm pressure
Successful healing
Above 0.35 in arteriosclerosis
Above 0.45 in diabetes
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20
Q

Doppler ultrasound

A

Ultrasound waves travel from probe to vessels – bounce off of blood cells back to probe
Pitch – function of how fast blood cells moving – faster the cells move the higher the pitch
Loudness – function of how many blood cells the waves hit – the more cells hit the louder the sound

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21
Q

Doppler Ultra wave B intrep

A

Ventricles contract, aortic valve opens

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22
Q

Doppler Ultra wave c intrep

A

Ventricles relax, valve open, reflux in large arteries

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23
Q

Doppler Ultra wave d intrep

A

Aortic valve closes, pressure increases in large vessels

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24
Q

Doppler Ultra wave e intrep

A

Return to diastolic baseline

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25
Normal triphasic doppler ultra sound waves
Bidirectional Rapid upstroke/ downstroke Flow reversal Arterial wall rebound
26
pathological biphasic doppler ultra waves
Bidirectional Decreased peak height Partial loss of flow reversal Loss of arterial rebound
27
Monophasic doppler wave
Rounding of unstroke/downstroke Decreased peak height Absent flow reversal Absent elastic rebound
28
Severe obstruction
Loss of peak height Absent flow reversal Absent elastic rebound
29
Digital cuffs measure pressure | Healing potential
Toe pressure 30 mm Hg or below predictive of nonhealing ulcer
30
Transcutaneous Oxygen Pressure
Measures partial oxygen tension on skin surface Temp 45 degrees Celsius TcPo2 = arterial Po2
31
vasc anatomy
illac-femerol-popliteal-3 branches=ant tibial, post tib, perineal
32
PAD treat revascularization guidelines
Endovascular therapies Stenosis at all levels Short segment occlusions in Iliac or SFA Surgical bypass Long segment occlusions Surgical endarterectomy Occlusion or high grade stenosis at common femoral bifurcation Help to preserve SFA and profunda femoral artery
33
treatment options for PAD
``` Antiplatelet therapy Aspirin or Clopidogrel (Plavix) LDL cholesterol level of less than 100 mg/dL HgA1c of less than 7% Control of Hypertension Possibly with benefit of ACE inhibitor Tobacco cessation embelectomy angioplasty (baloon) ```
34
Risk factors PHD of PMH
``` Diabetes Coronary Artery Disease Hypertension Hyperlipidemia Obesity Aortic aneurism Age Race Hispanic African American Male gender ```
35
Metabolic risk factors diabeties
Hyperinsulinemia or hyperglycemia (2 hour PP after 100 gm oral dose > 200) Hypertriglyceridemia (> 150) and low HDL (130/85) Obesity: waist line > 40 inches in males, > 35 inches in females (waist alone will diagnose 80% of patients with metabolic syndrome) Every increase of 1% of HgA1c, risk factor for PAD goes up 28%
36
PAD risk facotrs continued...PSH, SH, FH, ROS
PSH Coronary artery stent placement or lower extremity stent placement SH Tobacco use FH Any family with history of risk factors or PAD ROS Same as HPI, may have someone coming in for other complaints and pick up PAD in this area
37
2 greatest risk factors for PAD
diabeites and smoking!!
38
PE derm
``` Skin thin, atrophic Lack of pedal hair Brittle rigid nails Cold Hemosiderin deposits May have waxy appearance Ulcers Gangrenous Granular with a lot of fibrotic tissue ```
39
Where palpate pulse during PE?
Palpate dorsalis pedis (tween 1st n second metatarsals) and posterior tibial (just behind medial maleoulus) pulses If not palpable may palpate popliteal and/or femoral pulses Doppler DP, PT and perforating peroneal
40
Cap refill time
May be greater than 3 seconds (push on end of toe wont be able to see through the nail)
41
Dependent rubor
Foot looks red when dependent, pale with elevation
42
Doppler | Triphasic
normal
43
Doppler biphasic
mild to moderate PAD
44
Doppler monophasic
Severe PAD
45
ABI normal
.9-1.3
46
PAD with intermitent claudication
.5-.9
47
less than .5vABI
severe limb ischemia, rest pain n ulceration
48
Guidelines for Obstruction | segmental pressures
20-30mmHg difference between adjacent cuffs 30 mmHg change along leg from thigh to ankle 20mmHg or more difference between opposite leg, same level
49
Wagners index
``` Ischemic Index = leg pressure/ arm pressure Successful healing Above 0.35 in arteriosclerosis Above 0.45 in diabetes ```
50
Doppler ultrasound
Ultrasound waves travel from probe to vessels – bounce off of blood cells back to probe Pitch – function of how fast blood cells moving – faster the cells move the higher the pitch Loudness – function of how many blood cells the waves hit – the more cells hit the louder the sound
51
Doppler Ultra wave B intrep
Ventricles contract, aortic valve opens
52
Doppler Ultra wave c intrep
Ventricles relax, valve open, reflux in large arteries
53
Doppler Ultra wave d intrep
Aortic valve closes, pressure increases in large vessels
54
Doppler Ultra wave e intrep
Return to diastolic baseline
55
Normal triphasic doppler ultra sound waves
Bidirectional Rapid upstroke/ downstroke Flow reversal Arterial wall rebound
56
pathological biphasic doppler ultra waves
Bidirectional Decreased peak height Partial loss of flow reversal Loss of arterial rebound
57
Monophasic doppler wave
Rounding of unstroke/downstroke Decreased peak height Absent flow reversal Absent elastic rebound
58
Severe obstruction
Loss of peak height Absent flow reversal Absent elastic rebound
59
Digital cuffs measure pressure | Healing potential
Toe pressure 30 mm Hg or below predictive of nonhealing ulcer
60
Transcutaneous Oxygen Pressure
Measures partial oxygen tension on skin surface Temp 45 degrees Celsius TcPo2 = arterial Po2
61
vasc anatomy
illac-femerol-popliteal-3 branches=ant tibial, post tib, perineal
62
PAD treat revascularization guidelines
Endovascular therapies Stenosis at all levels Short segment occlusions in Iliac or SFA Surgical bypass Long segment occlusions Surgical endarterectomy Occlusion or high grade stenosis at common femoral bifurcation Help to preserve SFA and profunda femoral artery
63
In grown toe nail warning!!!!
Beware of ingrown toenail procedures on patients without palpable pulse Patient may develop gangrene as result of procedure and lose the toe as a result

cardio pulm exam 2 (4 decks)

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