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1. Peripheral Vascular System Examination
2. The 6 Ps of critical ischaemia Pallor
Pulseless
Perishingly cold
Paraesthesiae
Paralysis
Pain
3. Arterial, Neurogenic and Venous Claudication
4. Arterial vs venous ulcers
6. Overview Introduction
Inspection
Palpation
Auscultation
Presenting the findings
7. Introduction You (name, role)
Confirm patient details (name, age, DOB)
Consent
Expose (lying, lower arms and legs)
8. General Inspection Around the room
(mobility aids, cigarettes, oxygen, medications)
From the end of the bed
(scars, cyanosis, ulcers/gangrene, cyanosis, pallor, muscle atrophy)
9. Closer Inspection I Hands
(Temperature, tar staining, capillary refill, tendon/palmar xanthoma)
Eyes
(xanthelasma, conjunctival pallor, corneal arcus)
Mouth
(central cyanosis, angular stomatitis)
Abdomen:
(obvious pulsations, masses, scars)
10. Closer Inspection II Legs
(dressings, signs of (pre) gangrene, ulceration, non-healing injuries around pressure points, skin changes, hair loss, pallor, damage from previous ulcers, scars from operations, varicosities)
Toes
(Ischaemic changes and guttering between toes and heels?)
Ask patient to wiggle toes
11. Palpation I Arms:
Radial pulse (+radial-radial delay)
Brachial pulse
BP
Neck:
Carotid pulse
Abdomen:
Abdominal aorta (>3cm?)
12. Palpation II Legs (distal? proximal)
Tenderness?
Temperature
Sensation
Capillary refill
Pulses
Femoral (together and with radial)
Popliteal (flexed and extended)
Posterior tibial
Dorsalis Pedis
Buerger’s test
13. Burguer’s test Part 1:
Raise legs 45degrees and hold 1-2mins
Part 2:
Sit patient down and ask them to hang their legs over bed (90degrees)
What would happen in ischaemia?
14. Auscultation Femoral
Aortic
Renal
Carotids
15. Completing the examination Ankle/brachial pressure index
What happens in ischaemia?
Examine the foot for sensation
16. Presenting the findings: “I examined Mr(s) X, a ...-year old lady/gentleman. The patient was calm, comfortable and conscious at rest. There were no parephenalia suggestive of vascular disease, or peripheral stigmata of vascular disease.”
17. On inspection there were no ulcers, skin changes, hair loss, scars or pallor.
On palpation, pulses were normal and the temperature and sensation in the legs were normal. Berger’s test was normal.
On auscultation, there was no evidence of bruits.
18. Venous System Legs whilst standing and supine
Inspection- long saphenous or short saphenous?
Palpation (temperature)
Elevate limb to 15 degrees and note the rate of venous emptying
Trendelenberg test
19. Trendelenberg test