Upper limb peripheral vascular examination Flashcards
What are the first parts of an introduction?
Wash hands
introduce self
patient details - name + DOB (age)
Explain an upper limb peripheral vascular examination to a patient
I’ve been asked to examine the blood supply to your arms today
It’s going to involve me having a general inspection of your arms, legs, face and chest before having a feel of your pulses in your arm and legs and listening with my stethoscope.
What else would you include in an introduction?
For this I’m going to need you to take your top off if that’s okay?
Would you like a chaperone?
Are you in any pain or discomfort?
How do we break down a upper limb peripheral vascular exam?
Inspection and palpation 1 = General, bedside,
hands, arms and
neck.
Inspection and palpation 2 = eyes, mouth and
abdomen
Auscultate
When inspection generally and the bedside what are you looking for?
Are they comfortable at rest?
Any mobility aids, dressings or limb prosthesis.
Evidence of cyanosis or pallor of the limbs.
When inspecting the hands what are you looking for?
Skin colour
Tar staining;
Tendon xanthomas;
Gangrene;
What changes in skin colour may you see and what might you be worried about?
Cyanosis
pallor -> ? Raynaud’s
Erythema
True or false:
- Smoking is a risk factor
for PVD
True
What are tendon xanthomas associated with?
Hypercholestrolaemia
Is gangrene and what causes it?
Necrosis secondary to inadequate limb perfusion.
What 2 things other than pulses are you palpating for in the hands and arms?
CRT
Temperature
What is a normal CRT?
<2 seconds
What could a cold / pale limb indicate?
What could a long CRT indicate?
Poor arterial supply
Poor perfusion
What pulses do you assess in palpation 1?
Radial pulse
Ulnar pulse
Brachial pulse
Carotid pulse
What are we assessing when palpating the radial pulse?
Rate
Rhythm
Volume
Radial-radial delay.
What can radial-radial delay be associated with?
Subclavian artery stenosis from compression by a cervical rib or aortic dissection.
What do you assess when palpating the ulnar artery?
What test do you want to perform?
What does this test assess?
Volume
Allen test
Both arteries perfuse hand fully so palmar arches are intact
What do you assess when palpating the brachial pulse?
volume
character
What and how do you assess when palpating the carotid pulses
Character + Volume
Palpate one at a time
When inspecting the eye what are you looking for?
Conjunctival pallor
Corneal arcus
- yellowish/grey ring
surrounding the iris
How do you look for conjunctival pallor
Ask patient to gently pull down their lower eyelid
What do the following indicate?
1 - conjunctival pallor
2 - corneal arcus
1 -Anaemia
2 -Hypercholesterolaemia
When inspecting the mouth what are you looking for?
Central cyanosis (bluish discolouration of the lips and/or tongue).
Dehydration.
When inspecting the abdomen what are you looking for?
Scars
Visible masses
Visible pulsations.
