6.2a arterial

auscultation (graft)

inspection (web space, head of 5th metatarsal, heel)

palpation

Buerger's test

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popliteal aneurysm

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AAA

position exposure

complete (cardiovasuclar & peripheral vasuclar examination) some vital sigsn, input outpu

general

bedside

others

acute ischmic changes and chronic trophic changes (chronic has diff size, muscle wasting 鳳爪)

shiny skin

scars, graft, amputation

web space: poor blood supply (gray nail: easy: fungal infection)

5 ischemic ulcer (white means aropic red means venous like infectious)

4 gangrene

3 pre-gangrene

wasting pulps toes

x tissue crepitus

2 blister

thick, scaling skin

tender, cold, capillary

Buerger's test

soft, swollen, infected: x clear line of demarcation (wet gangrene) v infection/imparied venous drainage

hard, shrunken, non-infected: v clear line of demarcation (dry gangrene) x infection/impaired venous drainage

dead tissue (black, crinkled, withered)

discharge

depth

edge

gangrene x pain, prox to line v pain

base

site: number, shape, size

ulcer/skin tender, cold peripheral

(colour) punched-out edge

(colour) x granulation tissue

very deep with exposure of xxx?

infection

1 colour changes

purple (gang/ulcer)

blue

pallor, red, purple (gangrene)

mottled

acute ischemia

chronic ischemia

severe ischemia

infection

dystrophic nail

no hair 1st

temperature 1

graft

carotid artery

renal artery, aortic bifurcation, iliac artery

femoral artery, superficial femoral artery

weak pulses

capillary refill 2

peripheral pulse 3

Buerger's disease

lower limb

dorsalis pedis

ulnar

posterior tibial

brachial

subclavian

carotid

popliteal

femoral

radial

venous guttering

Buerger's angle

pre-gangrene

pallor

capillary refilling

reactive hyperemia

critical ischemia: <20°

critical ischemia: 15-30s

15°

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acute

chronic

ABPI

rhythm, bruit, murmur

rhythm

blood pressure in both arms

urine glucose? DM?

abdominal exam: AAA

connective tissue disease e.g. Raynaud

palpation

auscultation

inspection

COMPLETE

1 deep breath, 2 hold your breath

deep palpation

(rupture) bedside ultrasound AP diameter, HT, COPD (surgery) cardiopulmonary system, renal function, carotid?

iliac aneurysm, retroperitoneal hematoma

systolic bruit

light palpation

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-horizontal diameter-

x mobile, skin, muscles

consistency is firm

smooth surface, regular border, get above (supra/infra-renal aneurysm), get below (vx iliac aneurysm)

lower limb pulse: popliteal aneurysm, acute ischemia

continous bruit

partial blockage

arteriovenous communications

COMPLETE

prone

auscultation

palpation

inspection

prominent popliteal pulse

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x tender, x warm, expansile pulsation (demonstration)

systolic bruit

smooth surface, regular border, get above get below

consistency is firm

mobile in (?) direction, skin, muscle

x tender, x warm, expansile pulsation (demonstration)

-horizontal diameter-

knee flexion: x change in size (Baker's Street, semimembranous bursa)

continous bruit

partial blockage

arteriovenous communications

BILATERAL: contralateral

lower limb pulse: AAA, acute limb ischemia

Dopper

systolic pressure

brachial artery/dorsalis pedis

.>1 calcification

<1 occlusion

<50mmHg: critical isch

Fontaine stage I

Fontaine stage II

Fontaine stage III

Fontaine stage IV

asymtomatic

intermittent claudication

rest pain

gangrene/ulcer

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0.5-0.8

0.3-0.5

0.2

lesion: tender

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