All pulses should be examined .
Compare the pulses bilaterally
- Carotid
- Radial
- Femoral
- Dorsalis pedis
- Posterior tibialis
- Compare them bilaterally
- Palpate (1 at a time) arteries for:
- rate, rhythm, pulse contour, amplitude, symmetry, or any
- obstructions to flow
Peripheral Arteries includes
- Temporal - Carotid - Renal - Abdominal aorta - Femoral
Look out for
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Look for bruit (indicates arterial stenosis)
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Look for signs of arterial insufficiency. 5Ps Pain, Pallor, Pulselessness, Paresthesias, Paralysis. (Pain is the earliest sign) are the signs of acute leg ischemia.
Examination of peripheral veins:
-
inflammation or thrombosis of a vein may cause local discomfort or pain.
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Manifestations of venous obstruction depends on site, extent and adequacy of collateral vessels
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Cyanosis and oedema are signs of venous obstruction.
Signs to look out for
Thrombophlebitis Exam Y
Thrombophlebitis of small saphenous vein. Thrombosis of this or other superficial veins seldom leads to pulmonary embolism unless deep veins are also involved
In thrombosis of soleal veins there may be tenderness of calf, and tissue there may have a “doughy” feel. There may also be a difference in skin temperature between legs
In extensive thrombosis of deep veins, limb may evidence swelling, ranging from extreme to minor, or may appear relatively normal. Circumference of both legs and thighs should be measured at same levels and without compression
Dorsalis pedis pulse may be absent because of vasospasm secondary to escape of serotonin from obstructed veins
Homans sign: sharp dorsiflexion of foot with knee extended causes pain in calf resulting from tension of soleus and gastrocnemius muscles. This is evidence of calf vein thrombosis
Thrombophlebitis Exam - Calf pain associated with forcible dorsiflexion of the foot - Increased calf and thigh circumference - Fever - Difficulty ambulating due to pain
DVTs become life threatening when the thrombus detaches and becomes an embolus