Peripheral Arterial Disease Examination

Question 1

What are the steps involved in the PAD examination?

Answer 1

Vital signs
Blood pressure
Observation
Auscultations

(Limb specific exam)
Palpation
Special tests

Question 2

What do we access with vital signs?

Answer 2

Access pulse at : Wrist (radial artery), brachial artery, Neck (Carotid artery)
Breathing (BPM)
Temperature

Question 3

What is the process of blood pressure?

Answer 3

Find estimation of systole? (Osculatory gap)
Place bell over artery to the estimated range
Very slowly release until you can hear heart beat = systole Keep slowly releasing and when the heart rate can’t be heard = diastole

Question 4

What is involved in the observation stage for PAD?

Answer 4

1. Inspect the entire limb, comparing bilaterally, both upper and lower
2. Fingertips & nail beds
   a) check general health & appearance
   b) brittle nails
   c) clubbing
3. Skin
   Colour: pallor, redness
   Hair distribution
   Atrophy
   Poor wound healing, ulcers, gangrene
4. Compare limb size & symmetry
   Oedema, Reduced limb circumference

Question 5

What does brittle nails indicate?

Answer 5

Ischemia

Question 6

What does clubbing of the fingers indicate?

Answer 6

Chronic hypoxia

Question 7

What does pallor of the skin indicate?

Answer 7

Arterial obstruction

Question 8

What could redness of the skin indicate?

Answer 8

Inflammation and infection

Question 9

What does reduced hair distribution, thinned shiny skin, poor wound healing, ulcers and gangrene indicate?

Answer 9

Chronic ischemia

Question 10

What can oedema and muscle atrophy indicate?

Answer 10

Inflammation and chronic ischemia

Question 11

What is involved during auscultation of the patient?

Answer 11

Use the bell of the stethoscope and listen to the
- Abdominal aorta
- Renal arteries
- Iliac arteries
- Femoral arteries

Question 12

What are we looking for in auscultation and what may it indicate?

Answer 12

Bruits, it may indicate arterial obstruction

Question 13

What is involved in the limb exam palpation?

Answer 13

Palpate the pulses (Radial, Brachial or Dorsalis pedis, Posterior tibial, Popliteal, Femoral)

Abdominal aorta (the diameter should be about <3cm)

Temperature of limb (coolness may indicate poor arterial flow, excessive warmth may indicate inflammation)

Oedema of limb(Pitting oedema may indicate heart or renal failure)

Question 14

What are we noting about the pulses?

Answer 14

The average BPM
Rhythm
Character

Question 15

What is pulse volume?

Answer 15

The movement imparted to the finger by the pulse

Question 16

What is pulse contour?

Answer 16

The shape of the pulse wave (rise time; fall time; width or duration)

Question 17

What is the pulse strength?

Answer 17

The grading of the pulse
3+ (bounding)
2+ (normal)
1+ (diminished)
0 (Absent)

Question 18

What are thrills?

Answer 18

Vibrations felt in result of turbulent blood flow

Question 19

What is involved in the special tests?

Answer 19

EITHER LIMB - Nail bed (capillary refill test)
UPPER LIMB - Allen test
LOWER LIMB - ABI index

Question 20

What are the three special tests looking for?

Answer 20

Nail bed compression (slow refill - obstruction or heart failure)

Allen test (slow or absent return - obstruction in the radial or ulnar arteries)

ABI Index (ratio of arterial pressure from lower and upper limb)

Question 21

What are the 6 P’s for acute blockage or obstruction?

Answer 21

Pain
Pallor
Perishingly cold
Pulseless
Paraesthesia (neurological ischemia)
Paralysis