Peripheral Vascular Exam

Question 1

Inspection for Peripheral Vascular Exam

Answer 1

CUSH VESMIN

C; color– pallor, brown spots (hemosiderin deposits for venous insufficinecy, redness or rubor

U; ulceration– for arterial insufficinecy, might see ulcers on pressure points (toes and heels). For venous insufficiency, would see on medial malleolus– and painless.

S; skin– for AI; thin skin. For VI; thick callous skin.

H; hair– for AI; no leg hair on lateral side. for VI; maybe no toe hair.

V; varicose veins

E; edema (pitting edema indicates VI)

Scars

M; muscle wasting

I; inbetween toes; for fungal infections, broken skin, infection, ulceration.

N; nail growth and appearance.

Question 2

Compare arterial and venous insufficiency findings

Answer 2

arterial

skin: pallor

skin thickness; thin

ulcers; toe and heel

no edema

hair; lateral hair loss

rubor with dependency/reactive hyperemia

veinous insufficiency

skin; brown hemosiderin depositions

thick skin

medial ulcerations

pitting edema

stasis dermatitis

Question 3

Overall palpation sequence

Answer 3

1. temperature
2. cap refil
3. edema
4. measure calf circumference
5. artery palpation:
   - brachial
   - radial
   - abdominal aorta
   - femoral
   - popliteal
   - posterior tibial
   - dorsal pedis.
6. radio femoral delay– expect to feel femoral first
7. evaluate the peripheral palpable blood pressure.

Question 4

when you palpate the arteries, how to you characterize them?

Answer 4

for the radial and brachial artery, you characterize it in terms of rate, rhythm, amplitude, contour, symmetry

for all other artiers palpated (ex/ the ab aorta, the femoral, popliteal, posterior tibial and dorsalis pedis), characterize it in terms of symmetry and amplitude

Question 5

what do for during auscultation

Answer 5

1. auscultative blood pressure– you already took the peripheral blood pressure.
2. explain pulsus paradoxus.
3. listen for bruits on brachial, abdominal aorta, renal, iliac, femoral.

Question 6

what is pulsus paradoxus

Answer 6

Pulsus paradoxus refers to a systolic pressure drop greater than 10mmHg during inspiration. Pulsus paradoxus results from alterations in the mechanical forces imposed on the chambers of the heart and pulmonary vasculature and is often due to pericardial disease, particularly cardiac tamponade and to a lesser degree constrictive pericarditis.

pump the BP cuff up to just above expected systolic pressure. Ask the patient to inhale– if you can only hear the systolic on exhale but it disappears on inhale– mark this sign.

continue dropping the BP pressure. mark the point where you can hear the systolic jorotkoff sound when the patient both inhales and exhales.

the point difference should be less than 10

Question 7

UE test for arterial insufficinecy

Answer 7

Allens test

Question 8

LE test for arterial insufficiency

Answer 8

straight leg test and regil.

• look for rubor on dependency which might indicate an artierial insufficinecy and subsequant collateral vessel dilation