Peripheral Vascular Exam Flashcards
during PMHx. for peripheral vascualr
conditions you want to be aware about….
medications….
social…
- HTN
- CAD
- heart disease
- hyperlipidemia
- DM
- cancer
- thrombotic disease
- rhumatologic disease
- neurologic disease
- known peripheral vascular disease
surgeries!!!
medications
- anti-coags.
- asprin
- thrombolytics
- OCPs, etc.
social
- travel
- smoking
- alcohol
- immunization
- exercise
reasons for low JVP
reasons for high JVP
low: dehydration, low cardiac output
high: heart failure (right), pericarditis
Grading of pulses
what is 4+? what is 1+, 0+?
4+ = a bounding pulse …. not good
3+ increased from normal
2+ is brisk NORMAL FINDING
1+ dimished
0+ is absent
signs of arterial insufficency?
- cool, shiny legs
- hairless
- lateral malleous ulcer or ulcer at the base of toes
- hypertrophied toe nails
signs of venous insuffciency?
- hemosiderein deposits giving red/brown hue
- flaky skin
- edema/swelling
- medial malleous ulcers with weeping wounds
palpable pulses
- femoral
- popliteal
- posterior tibialis
- dorsalis pedis
what is the Allen test
- testing blood flow to the hand
- pt. makes fist
- occlude both arteries
- open fist — observe pallor
- release ulnar artery and watch flow retrun (3-5 seconds)
- then repeat iwth radial
what would be found with postural color changes
arterial insufficiency
- pt. lays supine – elevates legs unil pale
- then swips them over bed to observe for color chagne
- normal color return: less than 10 seconds
- to fill veins and ankles: 15 seconds
what is the ABI?
ankle-brachial index
- assesses for peripheral arterial disease
- measures systolic pressures in the brachial and dorsalis pedis arteries
- using doppler US
- compare pressures
- normal: 0.9-1.2
what is the trendelenburg test?
- assess competency of the venouse valves (in saphenous veins)
- pt. lays, and elevates legs to 90 degrees to drain blood
- tournequet applied to above the knee
- have pt. stand up
- observe filling: normal is slowly over 30 seconds
- rapid filing after the removal of the tournequet indicates a problem
what is an acute arterial obstruction?
sudden onset of pain diffuse throughout the limb, absent pulsese becuase a clot/emboi is occulding the whole blood supply
the 5 Ps!
- pain
- pallor
- pulsnessness
- paresthesias
- paralysis
can lead to gangrene if untreated
chronic arterial insuffiency
exam findings
-
PAIN : typically intermittent claudication: progressing to pain even at rest
pain gets worse with elevation (not getting the blood there) - cool limbs
- pale, shiny appearance
- loss of hair
- dependent rubor
- thickened nails
- decreased pulses
- ulcerations on toes or boney areas with poor O2 flow
- gangree can results
Chronic venous insuffiency
exam findings
- minimally painful: if its there they will say “achy”
- discoloration and flakey skin
- thicken, fkaley and dull skin
- brown discoloration
- ulcerations atht e sides of ankles (medial)
- edema!!! (valves arent working, cant get blood back up)
- normal temperature
- no risk of gangrene
superfiscial thrmobophelmbitis
- pain and redness along a vein location
- normally after an IV insertion
- red, induration, tender and can be swollen
- could be sign of malignancy if not an IV site
DVT
- persistant “crampy” pain (calf)
- red, swelling of the extreminity with 3+cm difference between legs
- +/- palpable cords (the backed up blood in vein)
- homanns sign
- increased risk of thrombosis (PE!!)
