© Continuing Medical Implementation …...bridging the care gap Examining the Peripheral Pulses
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How to Examine the Heart Examining the Peripheral
Femoral
Popliteal
Examination of Pulses
Venous refill with dependency (should be less than 30
seconds)
Bruits
Trophic Changes
dependent rubor associated with peripheral arterial
occlusive disease of the patient's right foot
© Continuing Medical Implementation …...bridging the care gap
Pallor on elevation
Rubor on dependency
Digital Ischaemia
Acute Arterial Insufficiency:
Measurement of the Ankle-Brachial
Figure 1. Measurement of the Ankle-Brachial Index (ABI).
Systolic blood pressure is measured by Doppler ultrasonography in
each arm and in the dorsalis pedis (DP) and posterior tibial (PT)
arteries in each ankle. The higher of the two arm pressures is
selected, as is the higher of the two pressures in each ankle. The
right and left ankle-brachial index values are determined by
dividing the higher ankle pressure in each leg by the higher arm
pressure.16 The ranges of the ankle-brachial index values are
shown, with a ratio greater than 1.30 suggesting a noncompressible,
calcified vessel. In this condition, the true pressure at that
location cannot be obtained, and additional tests are required to
diagnose peripheral arterial disease. Patients with claudication
typically have ankle-brachial index values ranging from 0.41 to
0.90, and those with critical leg ischemia have values of 0.40 or
less.
© Continuing Medical Implementation …...bridging the care gap
Venous Abnormalities
Spider Veins
Venous Insufficiency
Stasis Dermatitis/Ulceration
Edema
Cellulitis vs DVT