Peripheral Vascular System & Ischemia Flashcards
What undesirable effect can arise from an axillary block?
Failure to effectively block the radial nerve
Where can you palpate pulses in the legs? (4)
- Femoral artery-felt below the inguinal ligament
- Popliteal artery-behind the knee
- Dorsalis pedis artery-dorsum of the foot
- Posterior tibial artery-behind the medial malleolus of the ankle
Identify the veins
Although unreliable to determine BP without sphygmomanometer, carotid pulse indicates systolic pressure=___ and radial pulse indicates systolic pressure=____.
60
90
What do these grades mean when measuring arterial pulses?
+4
+3
+2
+1
0
Bounding
Increased
Brisk, expected
Diminished, weaker than expected
Absent, unable to palpate
What do you ask patients concerning vascular history? (6)
Pain in the arms or legs
Intermittent claudication
Cold, numbness, pallor in the legs; hair loss
Color change in fingertips or toes in cold weather
Swelling in calves, legs, or feet
Swelling with redness or tenderness
During the vascular exam , what do you check in the arms? (3)
Size, symmetry, skin color
Radial pulse, brachial pulse
Epitrochlear lymph nodes
How do you correctly examine the epitrochlear lymph nodes?
Patient’s is elbow flexed to about 90°. The right epitrochlear area is approached by inserting the examiner’s left hand from behind the patient’s elbow while the examiner’s right hand grasps the right wrist of the patient, supporting the forearm. The fourth and fifth finger fall above the medial epicondyle of the humerus and then the other fingers fall on the epitrochlear nodes.
________ refers to when, after pressure is applied to a small area, the indentation persists for some time after the release of the pressure.
pitting edema
What are some things to keep in mind when performing the Allen’s Test? (3)
- patient’s hand should be elevated above his or her heart
- patient’s should be asked to make a fist
- hand should return to normal color within 5-7 seconds
What can be the causes of peripheral edema?
aging, congestive heart failure, trauma, alcoholism, altitude sickness, pregnancy, hypertension, Sickle Cell Anemia, long periods of time sitting or standing without moving. Some medicines (e.g. amlodipine, pregabalin) may also cause or worsen the condition.
What vascular disease involves a sudden interruption in the arterial blood supply to a tissue, organ, or extremity that, if untreated, can lead to tissue death?
Acute Arterial Occlusion “Cold Leg”
Clinical manifestations of acute arterial ischemia include the “six Ps”:
- pain
- pallor
- pulselessness
- paresthesias
- paralysis
- poikilothermia
What is the treatment for acute arterial occlusion or “Cold Leg”?
injection of an anticoagulant, thrombolysis, embolectomy, surgical revascularisation, or amputation.
What condition may also cause nails to become brittle with longitudinal ridges?
Raynaud’s Phenomenon
What is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other areas>
Raynaud’s Phenomenon
What is the inflammation and thrombosis of superficial veins that presents as a painful induration with erythema, often in a linear or branching configuration forming cords?
Superficial Thrombophlebitis
What are the symptoms of superficial thrombophlebitis?
Vein may feel tender or hard like a cord when you touch it, and worm-like veins seen just under the skin.
Fever, redness, swelling, or pain in the area of the blood clot, skin feels hot or warm are others.
What is the treatment for superficial thrombophlebitis? (4)
Antibiotics
NSAIDS
Anticoagulation
Surgery
What condition mainly affects the large veins in the lower leg and thigh?
Deep Venous Thrombosis
What may occur after deep vein thrombosis (when the disease is called postthrombotic syndrome) or phlebitis?
Chronic Venous Insufficiency
What are symptoms associated with chronic venous insufficiency?
Itching (Pruritis), hyperpigmentation, warmth, swelling (edema)
What is the treatment for chronic venous insufficiency?
Manual compression lymphatic massage therapy, sequential compression pump, ankle pump, compression stockings, blood pressure medicine
How long does an surgical AV fistula take to develop?
over a period of months after the surgergy
What part of the common carotid artery is the common site for atherosclerosis?
Bifurcation
How is carotid artery disease dignosed?
Diagnosed by carotid bruits on exam then by color flow duplex ultrasound scan of the carotid arteries.
What is an aortic dissection?
A tear of the intima of the vessel wall
What are the causes of aortic aneurysms? (4)
HTN
Marfan syndrome
bicuspid aortic valve problems
blunt trauma
At what size is an aneurysm likely to rupture?
2 inches, 5cm
What are indications that a aortic aneurysm has ruptured?
Rupture=chest, abdominal, and back pain, patient appears in shock but initially hypertensive
What are the treaments for aortic aneurysms? (2)
- open surgery typically involves dissection of the dilated portion of the aorta and insertion of a synthetic (Dacron or Gore-Tex) patch tube
- endovascular treatment of aortic aneurysms involves the placement of an endo-vascular stent via a percutaneous technique
