vascular examination
DESCRIPTION
Pemeriksaan ekstremitas vaskularTRANSCRIPT
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The Vascular Examination
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As with any examination
•I•P•E•E•P
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•Introduce•Permission•Explanation•Exposure•PAIN
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Varicose vein examination
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Inspection•With patient standing, comment on:
•Distribution - “The patient has tortuous varicosities in the distribution of the long/short saphenous vein"
•Signs of poor skin nutrition• Venous stars (venulectasias).
• Superficial thrombophlebitis, which shows as a red, painful lump
• The brown pigmentation of haemosiderin deposition characteristic of increased venous pressure
• Venous eczema
• Ulceration and scarring from previous ulceration, especially in the gaiter area
• Lipodermatosclerosis
• Scars from previous vein surgery
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Palpation
•Run hand up veins feeling for increased warmth
•Palpate varicosities to assess • Hard/soft
• Tenderness
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Percussion
•Tap top of vein and feel how far down you can feel repercussions
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Saphenofemoral junction
•Trendelenberg• Lie patient down and empty veins
• place 2 fingers on SFJ
• Ask patient to stand
• If varicosities dont fill, SFJ incompetent
• If varicosities fill, incompetence lower down
• on releasing fingers, veins fill quickly = SFJ incompetent
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•Can also do tourniquet test• Similar to Trendelenberg
• Place tourniquet around leg
• If veins fill, incompetence is lower
• Move tourniquet down until filling controlled
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To complete examination
•“To complete my examination I would like to...”
• Doppler ultrasound - duplex
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Examination of the Chronically
Ischaemic Limb
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Inspection•Pale•Atrophic skin - shiny/red/dry•Ulcers - punched out, distal toes, in
between toes•Missing parts!
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Palpation
•Run back of hand from toes to groin•Feel warm/cold•Palpate pulses
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Femoral
•Midway between pubis symphysis and anterior superior iliac spine
•Midpoint of the inguinal canal
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Popliteal
•Place thumbs on tibial tuberosity•part heads of gastrocnemius with
finger of both hands•press against back of tibia
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Posterior Tibial
•Midway between medial malleolus and tip of calcaneus
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Dorsalis Pedis
•Lateral to tendon of extensor hallucis longus
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Buerger’s Angle/Test
•Should not do!•If asked:
• elevate leg
• estimate angle at which leg becomes pale - Buerger’s angle (<45∘)
• Re-elevate to 45∘ for 1-2 minutes until pale
• Hang leg off end of bed
• If becomes blue then red (reactive hyperaemia) Buergers test is positive
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To complete examination
•“To complete my examination I would like to........”
•ABPI• BP in brachial artery
• BP in dorsalis pedis using ultrasonic probe• 1= normal
• 0.6-0.9 = claudication
• 0.3-0.6 = Rest pain
• <0.3 = critical ischaemia
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Practice makes perfect
?