Peripheral Vascular Exam Flashcards
What are the 3 arterial pulses of the UE?
1) Brachial
2) Radial
3) Ulnar
What are the 4 Abdominal pulses?
1) Aorta
2) Renal
3) Iliac
4) Mesenteric
What are the 4 pulses of the LE?
1) Femoral
2) Popliteal
3) Posterior Tibial
4) Doraslis Pedis
What are the two venous systems of the LE (what are the major veins in each)
1) Superficial
- Great Saphenous
- Small Sephenous
2) Deep
- Femoral
- Popliteal
What are the two major lymph nodes of the UE?
1) Epitrochlear node - 3cm above the medial epidondyle
2) Axillary nodes - Multiple in the axilla
What may an enlarged Epitrochlear node indicate?
It could mean HIV
What are the two major lymph nodes of the LE?
1) Horizontal Superficial inguinal nodes - Lie in a chain in the proximal anterior thigh just below the inguinal ligament.
2) Vertical Superficial Inguinal Nodes - Lies in a cluster in the upper part of the Saphenous vein
What are the 5 P’s of acute arterial compromise?
1) Sudden Pain
2) Pulselessness
3) Pallor
4) Paraesthesia (numbness)
5) Paralysis (sudden weakness)
What are symptoms of chronic arterial compromise?
1) Intermittent Claudication
2) Rest Pain
3) Tissue damage
What are the 3 ways tissues can be lost in chronic arterial compromise?
1) Peripheral - ulcer
2) Cerebral - TIA/CVA
3) Visceral - Mesenteric Ischemia or Bowel infarctoin
What are 4 characteristics of arterial problems
1) Arterial Circulatory Compromise (most common)
a. Acute = Embelous
b. Chronic = Thrombosis
c. Compression = Positional/Postural
2) Bleeding = Rupture of an Aneurysm or trauma
3) Spasm = Raynaud’s disease
4) Inflammation = Arteritis
Symptoms of peripheral vascular disease are always _____ to the site of obstruction
Distal
What are arterial causes of Peripheral vascular disease
1) Atherosclerosis (thrombosis/embolic )
2) Diabetes
3) Vasospastic Disorders - Raynaud’s
4) Trauma
What are venous causes of Peripheral vascular disease?
1) DVT/PE
2) Varicosities
3) Venous Stasis disease
What are some s/s of Peripheral vascular disease?
1) Normal pulses
2) Brown patches or skin discoloration on legs
3) Dependent edema
4) Irregular shaped painless ulcers
5) Dependent cyanosis
6) Pain relieved by elevated legs
7) No intermittent claudication
8) normal nails
When checking the JVP how should the patient be and how should you be in relation to the patient
Patient should have his head elevated to 30-45 degrees and examiner should measure the JVP from the right
What JVP would be considered abnormal
7 cm or greater
When checking the arms in a PV exam, what should you be looking for
1) Size, symmetry or any swelling
2) Venous pattern
3) Color of nail beds
4) Capillary refill
5) Lesions or scars
What should you expect the normal capillary refill to be on the arm
Less than 2 seconds
When checking legs in a PV exam, what should you be looking for
1) Size, symmetry or any swelling
2) Venous pattern, enlargement or varicosities
3) Pigmentations, scars, ulcers or rashes
4) Color of nail beds
5) loss of hair on legs, feet and toes
6) muscle atrophy
7) Loss of toes
8) Obvious pulsate masses
What is the grading system of pulses
0 = Absent (can't feel) 1 = Diminished 2 = Normal 3 = Increased 4 = Bounding
When may you feel a bounding pulse
with hyperthyroid, fever, exercise or anxiety
What must you do before palpating the carotid pulse
Auscultate for bruits
What are the 2 places on the head and neck you want to check for a pulse?
1) Temporal
2) Carotid
What are 3 places on the head and neck that you want to auscultate for a pulse and bruit?
1) Temporal artery
2) Carotid
3) Supraclavicular and infraclavicular
What are 3 places on the Carotid that you would want to auscultate for bruits
Base, mid and at angle of mandible
What side do you want to use to listen to the head and neck pulses
The bell side (bilaterally)
What are the 3 main pulses you want to check in the arms?
1) Brachial
2) Radial
3) Ulnar
When checking the pulse of the arm bilaterally what difference in pulse numbers would indicate an abnormality?
More than 20 mmHg systolic or 10 mmHg diastolic from arm to arm
Define Orthostatic HTN
A decrease in systolic BP greater than 10 mmHg and increase in HR greater than 10 bpm with a change in position from sitting to standing
What does orthostatic HTN indicate
hypovolemia
Define Pulsus Paradoxus
A decrease in BP by more than 10 mmHg during inspiration
What may a Pulsus paradoxus indicate?
Cardiac tamponade, pericarditis, COPD, Chronic sleep apnea and croup
Why would you do an Allen’s test?
To determine the patency of the radial and ulnar arteries prior to A-line insertion (for example CABG or Cariac cath canulation). If one is occluded, you don’t want to risk collapsing the one working artery and get no flow into hand
How do you do an Allen’s test
Find both the radial and ulnar pulses, Hold both then let go of one and see how and how quickly the blood returns to the hand
Why is an Adson’s Maneuver/Wright’s test performed?
To test for thoracic outlet syndrome
How is an Adson’s Maneuver/Wright’s test performed?
Locate radial pulse (adson) extend and externally rotate arm head turned toward that side (Wrights) hyperabduct arm and rotate head and neck to opposite side. If pulse drops or is absent or feels numb that is a positive test for compression
What are the pulses you’re going to want to test in the LE?
1) Femoral
2) Popliteal
3) Posterior Tibialis
4) Dorsalis Pedis
What part of the stethoscope would you test for a femoral pulse/bruit
The bell side
What would you want to listen for on the LE pulses with a doppler
Bisphasic would mean normal
Monophasic or absent would mean abnormal
How would you do the Ankle/Brachial Index test?
Measure the systolic BP in both the brachial artery and compare that with the Posterior tibialis/dorsal pedis Artery. A normal reading the ankle bp should be the same or slightly higher than the brachial
What are the reading determinations for a Ankle/Brachial Index test?
1 - 1.2 is normal
Under 0.9 is mild to moderated PAD
Under 0.4 is severe PAD
Over 1.3 could be non compressible (DM or Chronic RF)
How would you palpate the abdominal aorta
Palpate just above the umbilicus with the patient supine. Try and find the edges of the aorta
What would the normal width of the abdominal aorta be and what would a larger AA indicate
It should be approx. 0.3 cm. If greater it may indicate Abdominal Aortic Aneurysm
What are the three pulses you would auscultate in the abdomen?
1) Abdominal Aorta
2) L/R Renal Artery
3) L/R Iliac Artery
How would you describe the venous system (as opposed to the arterial system)
A low resistance, low pressure vascular system
What are the 3 parts of the venous system?
1) Superficial
2) Deep
3) Perforating (connects the superficial to the deep)
All 3 venous systems have ______ ________ _______ ________ that permit flow from superficial to deep and distal to proximal
One way bicuspid valves
What are the 4 functions of the venous system?
1) Return deoxygenated blood to the heart
2) Storage - veins contain 70% of the total blood volume
3) Thermoregulation
4) Regulation of Cardiac Output
When measuring the circumference of the calf bilaterally where should you do it?
At the same point… 10 cm distal to the tibial tubercle
What is the gold standard in diagnosing deep vein thrombosis
Contrast venograms
Taking into consideration the sternal angle, how much should you add on to determine the JVP
Add 5 cm to the measurement obtained
When measuring the Ankle brachial index, what should you use to measure the blood pressure?
Doppler (stay consistent)
What would you recommend to someone with an Ankle brachial index of 0.9 - 0.99
Observation only, no treatment recommended
What would you recommend to someone with an Ankle brachial index of 0.8 - 0.89
Mild PAD, lifestyle modification (exercise, smoking cessation, diet, weight loss)
What would you recommend to someone with an Ankle brachial index of 0.51 - 0.79
Moderate PAD - Pharmacological treatment and lifestyle modification
What would you recommend to someone with an Ankle brachial index under 0.5
Severe PAD, refer to a vascular specialist (surgeon)
