PV Lecture Flashcards
What are the arterial pulses of the upper extremity?
Brachial
Radial
Ulnar
What are the arterial pulses of the lower extremity?
Femoral
Popliteal
Posterior Tibial
Dorsalis pedis
Describe the lower extremity venous systems
- Superficial (great and small saphenous)
2. Deep (femoral and popliteal)
What are the main lymph nodes of the upper extremities and where are they located?
- Epitrochlear (3 cm above medial epicondyle)
- Axillary (multiple here)
What are the main lymph nodes in the lower extremities and where are they located?
- Horizontal superficial inguinal (proximal anterior thigh just below inguinal ligament)
- Vertical superficial inguinal (upper part of saphenous vein)
What could an enlarged epitrochlear node indicate?
HIV
What are the symptoms of acute arterial PVD?
5 P’s:
- Pain (sudden)
- Pulselessness
- Pallor
- Paresthesias (numbness)
- Paralysis (sudden weakness)
What are the symptoms of chronic arterial PVD?
- Intermittent claudication
- Rest pain
- Tissue loss (peripheral, cerebral, visceral)
What are the types of arterial circulatory compromise in PVD?
- Acute (embolus)
- Chronic (thrombosis)
- Compression (positional)
What are the general characteristics that cause arterial PVD?
- Arterial circulatory compromise
- Bleeding (rupture of aneurysm or trauma)
- Spasm (Raynauds)
- Inflammation (arteritis)
Symptoms of PVD are always ___ to the site of obstruction
Distal
Aorto-iliac PVD results in ___ claudication
Gluteal
Femoral-popliteal PVD results in ____ claudication
Leg/calf
Axillary embolus results in ischemic changes in the ____
Forearm and hand
Brachial embolus results in ischemic changes in the ____
Fingers and hand
What are the main arterial causes of PVD?
- Athero
- DM
- Vasospastic disorders (Raynauds)
- Trauma
How does venous PVD present?
- Normal pulses
- Brown patches on lower legs
- Dependent edema
- Irregular shaped painless ulcers on lower legs and ankles
- Dependent cyanosis
- Pain relieved with legs elevated
- Normal nails
What are the main venous causes of PVD?
- DVT/PE
- Varicosities
- Venous stasis disease
How are pulses graded?
0 = absent 1+ = diminished 2+ = normal 3+ = increased 4+ = bounding
When can bounding pulses occur?
Hyperthyroid
Fever
Exercise
Anxiety
Which pulses of the head do we palpate?
- Temporal
- Carotid
How does orthostatic hypotension present?
From lying to sitting then standing
- Decrease in SBP 10+ mmHg
- Increase in HR 10+ bpm
What conditions could a pulsus paradoxus indicate?
- Cardiac tamponade
- Pericarditis
- COPD
- Chronic sleep apnea
- Croup
What is the purpose of Allen’s test?
- For patency of radial and ulnar arteries
- Prior to A-line insertion
- Prior to use of radial artery in CABG or cardiac cath
What is Adson’s Maneuver?
- Aka Wright’s test
- Pain/numbness in arms from compression of subclavian artery
- Indicates thoracic outlet syndrome
How does doppler classify blood flow in lower extremities?
Biphasic = normal
Monophasic or absent = abnormal
What is ABI?
- Ankle Brachial Index
- Measures SBP in brachial and compares with PT/DP in leg/foot using doppler
- Normal is 1.0 - 1.2
What are the classifications of ABI values from normal to PAD?
1.3+ = non compressible (DM and CKD)
1.0 to 1.2 = normal
Less than 0.9 = mild to moderate PAD
Less than 0.4 = severe PAD
If the aorta is greater than ___ cm width, it may indicate ____
3+ cm
AAA
Which arteries do we auscultate in the abdomen?
Aortic, renal, iliac
What is the perforating venous system?
Connects superficial to deep
Functions of venous system
- Return O2 poor blood to heart
- Storage (70% of blood volume)
- Thermoregulation
- Regulation of CO
