Peripheral vascular Flashcards
What do you look for on general inspection?
Scars
Amputations
Pallor
Cyanosis
What do you look for on close inspection of the hands?
Colour - cyanosis, pallor
Venous filling (reduced in PVD)
Xanthomata
Gangrene
What do you assess for on palpation of hands / upper limbs?
Temperature - reduces distally in PVD Cap refill Radial pulse (rate + rhythm, radio-radial delay - aortic coarctation) Brachial pulses (volume) BP in both arms Carotid pulses (volume + character)
What do you assess for on auscultation of the neck?
Carotid arteries - bruits
What do you palpate in the abdomen?
Abdominal aortic (expansile mass = AAA)
What do you auscultate in the abdomen?
Aorta - bruits
What do you look for on inspection of the legs?
Ulcers (arterial or venous, back of legs and in-between toes) Scars Hair loss Amputations Pallor
What do you assess on palpation of legs?
Temperature
Cap refill
Femoral pulse (mid-inguinal point)
Radio-femoral delay (aortic coarctation)
Popliteal pulse (increased pulsation –> aneurysm)
Assess light touch sensation (neuropathy / ischaemia)
What do you assess for on auscultation of the lower legs?
Femoral artery (bruits –> stenosis, aneurysm)
Popliteal artery
Posterior tibial pulse
Dorsalis pedis pulse
How do neuropathic, arterial and venous ulcers vary from each other?
Venous = occur in medial gaiter area most commonly, less painful, superficial, ass with atrophie blanche, varicose veins, varicose eczema, chronic venous HTN Arterial = intermittent claudication, pain, punched out ulcer in lower leg / foot, 5 Ps, associated with PVD Neuropathic = painless but warm with pulses, occur under metatarsal heads / heel
What special test would you do?
Beurger’s test
- Raise both legs to 45 degrees for 1-2 mins and observe for colour change
- If pallor occurs, observe the angle at which this occurs
- Hang legs over the edge of the bed –> return of colour (blue then red then normal)
