Vasculature

Question 1

What are the steps in a vascular examination?

Look, listen, feel, test

Answer 1

1. Name, DOB, introduction
2. Consent patient:
   “I’ve been asked to perform a vascular examination, this would involve taking a look at and manually examining your arms, legs, face and tummy, ideally it will be best if you can expose your entire leg and your tummy - are you comfortable to take part?”
3. Wash hands, check for pain
4. Observe around bed
5. Observe patient
6. Check hands:
7. CRT
8. Radial pulse, bilateral radial pulse - rate and rhythm
9. Both Ulnar pulses (If not possible then do Allen’s test) - palpable
10. Both brachial pulses - palpable
11. Both carotid pulses - volume and character
12. Check eyes - xanthelasma, corneal arch’s
13. Observe abdomen
14. Palpate abdominal aorta
15. Observe legs, feet and between toes - scars, hair changes, ulcers, atrophied changes, blisters, smooth, rough, infections; under/over
16. Check warmth of legs
17. Toe CRT
18. Swelling of legs
19. Palpate both femoral pulses
20. Palpate both popliteal pulses
21. Palpate both posterior tibial pulses
22. Palpate both dorsalis pedis pulses
23. Auscultate both carotids - hold breath (remove breath noises)
24. Ausculatate abdominal aorta and renal arteries
25. Offer Doppler US of dorsalis pedis and posterior tibial

Question 2

What comments should you make upon performing a vascular exam on a normal healthy person?

Answer 2

Comment on build of patient - normal build

No signs of:
Anorexia
Jaundice
Cyanosis
Clubbing

Blood pressure in both arms Is ….

Presence of heart sounds 1, 2 and no extra sounds

No carotid bruits present

Pink warm feet

No oedema

No skin changes

No varicose veins