Peripheral Vascular

Question 1

1 -

Be prepared for either upper or lower limbs

Answer 1

Inspect!! Bed area, patient …

Question 2

2

Answer 2

Inspect hands

temp
cap refill
general inspection

Question 3

3

Answer 3

• check one radial (rate, rhythm, volume…) then radial radio

- radial radio delay

Question 4

4

Answer 4

ulnar

Question 5

5

Answer 5

brachial

Question 6

6

Answer 6

Allens

Question 7

7

Answer 7

Check BP in both arms

Question 8

8

Answer 8

Palpate the carotid pulses (one at a time)

Question 9

9

Answer 9

Inspect eyes

Question 10

10

Answer 10

Inspect mouth (lips and tongue for central cyanosis)

Question 11

11

Answer 11

Inspect abdomen - INSPECT!!!! then ABDO AORTA

“for scars, visible masses and visible pulsations”

Question 12

12 LEGS

Answer 12

Inspect the legs, feet and toes for

o Symmetry
o Colour
o Scars
o Oedema
o Loss of hair
o Ulceration

Question 13

13

Answer 13

Palpate
o Aorta (put two hands down firmly above the umbilicus)
o Femoral pulses (going to feel the pulses in your groin, could i ask you to lower your boxers slightly for me)
AUSCULTATE THIS ONE
o Popliteal pulses (behind knee, bend it, thumbs on patella)
o Dorsalis pedis and posterior tibial pulses (two on foot)

Question 14

14

Answer 14

Ascultate these:
Carotids
Subclavian ? - above clavicle
aorta
femoral (try do before)

Question 15

15

• Check light-touch sensation and capillary refill in the toes
• Assess power in the foot/leg

Answer 15

Check light-touch sensation on toes - right, left, left….

ASSESSSSSSS FOR LIGHT TOUCH (on toes) +AND+ POWER
I reckon just do the foot extension and flexion

Question 16

16

Answer 16

Capillary refill in the toes

assess temp of leg/foot as well - GM

Question 17

17

Answer 17

Buergers test??? think say you would do it at the completion bit

Question 18

With the patient supine, elevate both legs to an angle of 45° and hold for one
to two minutes. Pallor of the feet indicates ischemia. The poorer the arterial
supply, the less the angle to which the legs have to be raised for them to
become pale (Buerger’s Angle)

Answer 18

o Then sit the patient up and ask them to hang their legs down over the side of
the bed at an angle of 90°. Gravity aids blood flow and colour returns in the ischemic leg. The skin at first becomes blue, as blood is deoxygenated in its passage through the ischemic tissue, and then red, due to reactive hyperaemia
from post-hypoxic vasodilatation. Both legs should be examined
simultaneously as the changes are most obvious when one leg has a normal circulation, (the time it takes to become pink/red relates to the severity or ischemia – Buerger’s time)

Question 19

19

Answer 19

Today i performed ….
no stigmata of peripheral vascular disease.

To complete:
- Buergers test if there was suspicion of critical ischaemia

• BP IN BOTH ARMS!!1
• Calculate ABPI (ankle-brachial pressure index)
  and do a full
• cardiac examination