Put your notes in here. Type them, publish them, view them, edit them, save it and print them. Notes are stored locally, if you clear your browser history they will disappear. Notes are a great way to add your own notes, from other sources to this station.
Cardiovascular Skills And Examination
Peripheral Vascular Examination
Wash your hands
Introduce yourself, explain what you are going to do and gain consent
Assess both limbs with the patient lying on a bed.
Look around for equipment including a hand-held doppler and BP cuff
- Tissue loss/ulcers/gangrene
- Discoloration (rubor, cyanosis)
- Swellings and atrophy
- Scars – LSV harvest, groin incision
- Test Temperature, Sensation and CRT in the limb
- Feel for pulses in the abdominal Aorta, Femoral, Popliteal, Dorsalis Pedis, Posterior Tibial vessels
- If there pulses feel weak or you are unable to palpate them place a handheld doppler with jelly over the Femoral, Popliteal, Dorsalis Pedis or Posterior Tibial vessels and note the waveform.
- The brachial and leg pressures should be compared.
- This is recorded as the highest brachial systolic pressure against the highest ankle pressure.
- A BP cuff is attached and doppler probe placed at the level of the artery. The cuff is then inflated until the signal disappears.
- Pt lie flat – ask about pain in legs etc
- Raise both legs to 45◦ and hold them for one minute
- Sit up and hang legs over edge of bed
- In PVD – elevation shows pallor as blood drains
- Dependent – shows bluish (deoxygenated blood over passage of tissue), then flush red due to hyperaemia from post-hypoxic vasodilation (reactive rubor)