Vascular Examination Flashcards
What are you looking for around the bed area?
Walking aids
Oxygen
Cigarettes / Smell of tobacco
What are you looking for on general inspection?
Any missing limbs or digits
Are they obese/cachexic
What signs are you looking for in the hands?
Tar staining Xanthomata (yellow lesions) Peripheral cyanosis Pale/blue fingers (raynauds) Cap refill Gangre
What would you do if you couldn’t feel the ulna pulse?
Allens test Ask patient to make fist Occlude radial and ulcer artery with 2 fingers from each hand Ask patient to open fist Release pressure on ulnar artery Colour should return in 10 seconds
What signs are you looking for in the face?
Corneal arcus (yellow ring around iris)
Xanthelasma
Central cyanosis in mouth
Signs of hypercholesterolaemia
What signs are you looking for in the abdomen?
Visible pulsations
Can you feel the aorta - note expansile pulsation might suggest AAA
What signs are you looking for in the legs
Colour - pallor or redness
Scars -
Trophic changes - changes in skin, shiny skin, loss of hair?
Venous disease - varicose veins, eczema
Ulcers - look under leg and between toes
Feel temperature
Cap refill in big toe
What are you listening for and where?
Bruits - turbulent blood flow
Listen:
- Abdominal aorta
- Femorals
- Carotid
What are the ranges for normal and abnormal ABPI?
>1.2 abnormally hardest vessel (can often be false negative) 1-1.2 normal 0.8-0.9 mild claudication <0.8 claudication <0.4 ischaemia
How would you carry out an ABPI?
Record systolic BP with appropriate sized cuff in both arms and both ankles
Take measurements manually using dappled probe - document nature of Doppler ultrasound signals
Calculate index in each leg by dividing the highest ankle pressure by the highest arm pressure
How would you complete a vascular examination?
Bloods - cholesterol and glucose Full cardiovascular examination BP ABPI - if indicated Lower limb neurological examination Further imaging (if required) - Duplex ultrasound /CT angiogram
