Arterial Exam (based on Browse’s, 3 rd edition) 123xss WIPER Chaperone offered Asks patient if there is any pain Inspection - Full 360 of each leg for o scars o colour o mottling (blue streaks around white patches – if this is fixed the ischaemia is irreversible) o ulcers especially at the pressure points and between digits o loss of hair may be a sign of chronic ischaemia but not very reliable - Q: Where would you expect gangrene first? - Establishes vascular angle o 15 to 30 degrees for 30-60 seconds may elicit pallor o Less than 20 degrees implies severe ischaemia o On returning to a dependent position, dusky red/blue implies ischaemia o Doing both legs together allows a comparison Palpation - Skin temperature – can only be assessed if both legs have been exposed to the same ambient temperature for 5 minutes! - Cap refill - Palpate the pulses simultaneously where possible o Upper limb o Femoral o Dorsalis pedis, in the v between the 1 st and 2 nd metatarsals, not present in 10% o Posterior tibial, just behind the medial malleolus o Popliteal o AAA Auscultation - Listen in
Arterial Exam (based on Browses, 3rd edition) 123xssWIPER
Chaperone offeredAsks patient if there is any painInspection Full
360 of each leg for scars colour mottling (blue streaks around
white patches if this is fixed the ischaemia is irreversible)
ulcers especially at the pressure points and between digits loss of
hair may be a sign of chronic ischaemia but not very reliable Q:
Where would you expect gangrene first? Establishes vascular angle
15 to 30 degrees for 30-60 seconds may elicit pallor Less than 20
degrees implies severe ischaemia On returning to a dependent
position, dusky red/blue implies ischaemia Doing both legs together
allows a comparisonPalpation Skin temperature can only be assessed
if both legs have been exposed to the same ambient temperature for
5 minutes! Cap refill Palpate the pulses simultaneously where
possible Upper limb Femoral Dorsalis pedis, in the v between the
1st and 2nd metatarsals, not present in 10% Posterior tibial, just
behind the medial malleolus Popliteal AAAAuscultation Listen in
Neck Abdomen Groin Thigh especially the adductor canal Bruits are
caused by turbulent flow beyond a stenosis or an irregularity in
the artery wallABPI
