Peripheral Arterial Disease Examination Flashcards
What are the steps involved in the PAD examination?
Vital signs
Blood pressure
Observation
Auscultations
(Limb specific exam)
Palpation
Special tests
What do we access with vital signs?
Access pulse at : Wrist (radial artery), brachial artery, Neck (Carotid artery)
Breathing (BPM)
Temperature
What is the process of blood pressure?
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
What is involved in the observation stage for PAD?
- Inspect the entire limb, comparing bilaterally, both upper and lower
- Fingertips & nail beds
a) check general health & appearance
b) brittle nails
c) clubbing - Skin
Colour: pallor, redness
Hair distribution
Atrophy
Poor wound healing, ulcers, gangrene - Compare limb size & symmetry
Oedema, Reduced limb circumference
What does brittle nails indicate?
Ischemia
What does clubbing of the fingers indicate?
Chronic hypoxia
What does pallor of the skin indicate?
Arterial obstruction
What could redness of the skin indicate?
Inflammation and infection
What does reduced hair distribution, thinned shiny skin, poor wound healing, ulcers and gangrene indicate?
Chronic ischemia
What can oedema and muscle atrophy indicate?
Inflammation and chronic ischemia
What is involved during auscultation of the patient?
Use the bell of the stethoscope and listen to the
- Abdominal aorta
- Renal arteries
- Iliac arteries
- Femoral arteries
What are we looking for in auscultation and what may it indicate?
Bruits, it may indicate arterial obstruction
What is involved in the limb exam palpation?
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)
What are we noting about the pulses?
The average BPM
Rhythm
Character
What is pulse volume?
The movement imparted to the finger by the pulse
What is pulse contour?
The shape of the pulse wave (rise time; fall time; width or duration)
What is the pulse strength?
The grading of the pulse
3+ (bounding)
2+ (normal)
1+ (diminished)
0 (Absent)
What are thrills?
Vibrations felt in result of turbulent blood flow
What is involved in the special tests?
EITHER LIMB - Nail bed (capillary refill test)
UPPER LIMB - Allen test
LOWER LIMB - ABI index
What are the three special tests looking for?
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)
What are the 6 P’s for acute blockage or obstruction?
Pain
Pallor
Perishingly cold
Pulseless
Paraesthesia (neurological ischemia)
Paralysis
