Components:
- Skin/subcutaneous tissue
- Musculo-skeletal system
- Arteries, Veins, Lymphatics, nervous
Procedure Process
- permission, introduction, ensure privacy, presence of nurse when patient is female
- handwashing
- Exposure; whole lower limb & cover groin & Position; start supine; but position needs to be changed according to needed parts of examination
- inspect & describe, compare between limbs, check for ulcers; in between toes, scars, hair distribution, swelling, check on back, dilated veins, versatile mass, skin color, masses, lumps, look at the back, examine thoroughly
- Ask patient wether there is any pain
- identify landmarks of arteries
Palpation
- Tenderness; check one limb at time
- assess temperature both limbs from lower to upper limb
- Palpate check pain markers
- Capillary refill, press nails - check nails refill timing 1-5 seconds normal
- pressing bony prominence of tibia to check pitting edema
palpation of Pulses
- Femoral artery; mid-inguinal point((cc)) - a line between ant. sup. iliac spine and symphysis pubis
- Popliteal; ask patient to flex leg to knee joint at 90 degrees - foot should be flat on the bed - using two hands technique, putting thumbs over tibial tuborisity, rest fingers at popliteal fossa by tip of your fingers against your thumbs till you feel the artery
- Posterior tibial artery; behind the medial malleus - behind 1cm & below 1cm medially of malleus. or two third one third technique of medial malleus
- Dorsalis pedis; first space, lateral to the extensor hallicus longus
Vascular angle
move leg 10 degrees every time until you find abnormal sudden blood filling???? ((cc)) change in color = positive - hman sign? in case of dvt, pain at calf muscle
Principles and Practice of Surgery
Pg. 319-362