Week 2 non-invasive vascular screening Flashcards
what kinds of skin things are we looking for with visual inspection
discoloration, hyper pigmentation dry cracked scarring hair loss thick yellow nails dermatitis, lipodermatosclerosis, atrophie blanche.
what are we looking for with veins
varicose veins
distention
what are we looking for both unilaterally or bilaterally and what are the 3 types
edema, soft, hard, pitting
hemosiderin staining is most common with
VI
what 3 things are we palpating for
temperature
pulses
edema
pulses are a ___ exam
macrovascular
how do we measure LE pulses and what two specifically
warm room and supine, especially the posterior rib and the dorsalis pedis (which is absent in up to 15% people)
capillary refil is a ____ exam
microvascular
what is normal capillary refill time
less than 3 seconds
what is a rubor of dependency test
you elevate the legs 30-60 degrees and you observe for pallor or blanching
what is the grading for rubor of dependency
normal: little to no color change
mild: 45-60 seconds to come on
moderate: 30 seconds to come on
severe: less than 25 seconds
then in dependency: what are you observing and how is it scored
the color
- less than 15 seconds to return is normal
- over 30 seconds and dark red (reactive hyperemia) = severe ischemic disease
why do you get hyperemia with the dependency test
when you elevate the legs, blood leaves, and you vasodilator to bring blood in, as when you go into a dependent position, you bring blood back in with you.
what is the venous filling time and grading
you are supine, legs elevated to 30-60 degrees, and you watch the veins in the top of the feet drain, 60 seconds. then dependent position. watch them refill.
normal filling is 5-15 seconds
over 20 seconds (arterial disease)
fill immediately (VI)
what is the ABI
ratio of ankle systolic and brachial systolic that is measured with a BP cuff and Doppler on the distal pulses of the leg
what are contraindications for this test
ulcer near the ankle
what are considerations for this test
calcified, non-compressible vessels will skew it.
DM, renal insufficiency, edema, obesity and poor CO.
how do we interpret the ABI
- over 1.2 is unreliable.
- 1-1.2 normal
- 0.8-1.0 is mild PAD
- 0.5-0.8 is moderate PAD with intermittent claudication below 0.8
- 0/.6-0.8 required you to be cautious with modified compression and night pain
- 0.5 or less is severe ischemia and rest pain
- 0.2 or less is tissue death
can we compress if ABI is less than 0.6
no contraindicated
at what value are compression and debridement absolutely contraindicated
less then 0.5
at what cut off is tissue death
less than 0.2 ABI
how do we test claudication onset time
walk on a treadmill at 1mph and level ground and record the time pain onsets.
why do we measure claudication onset time
supervised progressive walking program and tracking progress and endurance.
