Peripheral Arterial Examination Flashcards
General inspection
-things to look out for
Missing limbs/digits - amputation from past ischemia
Scars, ulcers
Dressings - compression for venous ulcers
Mobility aids
Upper limb
- inspection
- temperature, CRT
Peripheral cyanosis, pallor - poor perfusion
Tar staining - smoking status
Xanthomata - familial high cholesterol
Gangrene in fingers
Temperature
CRT
Upper limb pulses
Radial - superficial
-radioradial delay => aortic dissection, subclavian stenosis
Brachial pulse - deep
BP measurement
- wide pulse pressure => aortic regurgitation, dissection
- 20mmHg+ difference between arms => dissection
Neck pulses
Auscultate carotid before palpating
-carotid bruits
Abdomen
- inspection
- palpate
- auscultate
Obvious pulsation in EG midline
Palpate aorta - expansile => AAA
Auscultate aorta, renal arteries
-aortic bruits => AAA
-renal bruit => renal stenosis
Lower limbs
- inspection
- assessment of motor function
- temperature, CRT
Peripheral cyanosis, pallor Venous, arterial ulcers Gangrene Missing limb, toes, fingers Hair loss - arterial ulcer Muscle wasting - chronic PVD Xanthomata - familial high cholesterol
Paralysis - wiggle toes
Temperature, CRT assessmeent
Lower leg pulses
- femoral
- popliteal
- posterior tibial
- dorsalis pedis
Femoral - midpoint between ASIS, PS
- radiofemoral delay - should happen at the same time
- auscultate for bruits => femoral, iliac stenosis
Popliteal - deep
Posterior tibial - superficial
-post to medial malleolus
Dorsalis pedis - superficial
-lateral to ext hallucis tendon
Gross peripheral sensation assessment
Move distal => proximal with cotton wool and compare both sides
-note level at which deficit occurs
Berger’s test
Assess adequacy of arterial supply to leg
- patient supine
- raise both legs to 45deg for 2mins
- observe colour of limbs
- sit patient up, ask them to hang legs down over side of bed
- pink :)
- pallor => ischemia, assess the angle (U20 = severe limb ischemia)
- gravity will aid reperfusion of leg => blue => red
Further assessments
BP measurements
CV exam
ABPI exam - assess lower limb perfusion
Upper, lower limb neuro exam
