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peripheral arterial examination (closer inspection (comment on pallor /…
peripheral arterial examination
initial approach
introduces him/herself
explains what we will be doing
hand hygiene
obtains consent
ask about pain
i'm happy with the exposure (legs exposed) and 45 degree angle position of the patient
general inspection
marked leg pallor/ gross cyanosis
for the signs of peripheral vascular disease
absence of aids/ devices; O2, medications
amputations
wheelchair, prostheses
obvious scars
patient appears comfortable, under no distress
no cyanosis, normal weight
closer inspection
comment on pallor / marked leg pallor
hair loss / absence of hair
ask patient to lift legs and look between toes and base of feet
nail dystrophy / toenail dystrophy
skin changes/ eczema / dry skin
obvious ulcers/gangrene
amputations
muscle wasting
scars
palpation
check for pitting oedema, compress skin with your thumb
cap refill - compress toe nails
temperature with the back of the hand above and below the knee, compare two legs
pulses
popliteal artery - behind the knee; patient lying supine with knee slightly flexed; use both hands in the middle of the popliteal fossa; lies posterior to the knee joint
posterior tibial artery - palpate halfway between the posterior border of medial malleolus and the achilles tendon
femoral artery - halfway between the pubic symphysis and the anterior superior iliac spine
dorsalis pedis - palpated lateral to the extensor hallucis longus tendon; 1/3 of the way down a line joining the midpoint of the two malleoli to the cleft between the first and second toes
measure radial pulse at the same time
buerger's test
elevate legs to the angle at which pallor occurs; pallor is rapid if there is a poor arterial supply, healthy leg should remain pink
place legs over edge of the bed; reactive hyperaemia occurs if arterial supply is impaired; leg first returns to normal colour - pink, then turns red due to arteriolar dilatation