The peripheral vascular system: Examination of pulses

24 The peripheral vascular system


examination of pulses





Questions



image Which pulses would you feel?

image What is Buerger’s test?

image If the popliteal and foot pulses are absent on the left side only, where is the occlusion?

An OSCE might comprise intermittent claudication, critical limb ischaemia, abdominal aortic aneurysm, postoperative patient (abdominal aortic aneurysm repair (laparotomy) or bypass graft), amputation, diabetic foot or ulcer.




Introduction


For examining the leg pulses, the patient should be lying flat, both legs fully exposed. It is essential to ask if the patient is in pain (this provides a clue to the presence of critical limb ischaemia).



Look


A number of features can be identified just by looking from the end of the bed:


image trophic changes: thin poor shiny skin, hair loss, gangrene, ulcers

image colour: the legs are pale (pallor)

image pressure points: look at the toes and then specifically between the toes and underneath the heel for gangrene and arterial ulcers
— gangrene: black tissue, often starting at the tips of the toes; dry gangrene is non-infected and wet gangrene is infected

— ulcers: arterial ulcers are found on the toes and forefoot; they are ‘punched out’ and painful (Ch. 28)

image scars: into the groins: these are evidence of previous bypass surgery; a laparotomy may indicate abdominal aortic surgery (grafting)

image an epigastric pulsation may indicate an abdominal aortic aneurysm (this pulsation may be normal!)

image patients may prefer to sit with their legs hanging over the side of the bed: in critical limb ischaemia, this improves the arterial blood flow with the aid of gravity

image amputation: peripheral vascular disease is the most common cause of amputation; the amputation may be above or below the knee
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on The peripheral vascular system: Examination of pulses

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