Flashcards in Peripheral Vascular System + Ischemia/Infarction COPY Deck (82):
When are arterial pulses palpable?
When an artery lives close to the body surface
What vascular arches protect circulation to the hand?
1) Deep palmar arch
2) Superficial palmar arch
What four arteries are palpable in the leg
1) Femoral artery
2) Popliteal artery
3) Posterior tibial artery
4) Dorsalis pedis artery
Which artery protects the circulation of the foot?
Below what ligament is the femoral artery?
What aspects of a pulse should an observer note?
What aspects of blood vessels should an observer note when taking pulse?
Carotid pulse indicates systolic pressure =
Radial pulse indicate systolic pressure =
A grade of 0 means a pulse is
Absent, unable to palpate
A grade of 1+ means a pulse is
Diminished, weaker than expected
A grade of 2+ means a pulse is
A grade of 3+ means a pulse is
A grade of 4+ means a pulse is
When grading arterial pulses, we look at the right and left
Carotid, brachial, radial, femoral, popliteal, posterior tibial, dorsalis pedis
Vascular history = PICCSS
Pain in arms or legs
Cold, numbness, pallor in the legs; hair loss
Color change in fingertips or toes in cold weather
Swelling in calves, legs, or feet
Swelling with redness or tenderness
What lymph nodes are located in the arms?
Epitrochlear lymph nodes
Is peripheral edema more likely to occur in legs or arms?
What lymph nodes are located in the legs?
Inguinal lymph nodes
The S’s of the vascular exam
Hand to use in brachial pulse?
Describe position for brachial pulse?
Elbow slightly flexed
Forearm externally rotated
On what aspect can you find the brachial pulse?
Anterior aspect of elbow
To find brachial pulse, palpate:
Just medial to biceps tendon + lateral to medial epicondyle of humerus
In finding the epitrochlear nodes of the arm, the fourth and fifth fingers fall where?
Above medial epicondyle of humerus
What fingers fall on the epitrochlear nodes?
1-3 of left hand
If patient has elevated lymph nodes on one side, what condition?
What parts of the body do epitrochlear nodes drain?
Drain ulnar forearm, hand
What parts of the body do axillary lymph nodes?
Drain breast, upper extremity, thoracic wall
Which lymph nodes are affected most commonly by Non-Hodgkin’s lymphoma?
Which nodes are most commonly affected by skin infections, lymphoma, and skin malignancies?
Which parts of body drained by inguinal nodes?
Lower third of vagina
Max enlargement of normal inguinal lymph nodes?
1-2 cm in size
What two nodal groups classified as inguinal lymph nodes?
Horizontal + vertical node group
Swelling of tissues d/t accumulation of fluids
What medications may cause edema?
When, after pressure is applied to small area, indentation persists for some time after the release of the pressure
What circulation-related issues cause edema?
Aging, pregnancy, altitude sickness and alcoholism can all cause
Where should a patient’s hand be during an Allen’s test?
Above the heart
During an Allen’s test, within what frame of time should a fist return to normal color?
What is another name for “Cold Leg”?
Acute Arterial Occlusion
What is the name of a vascular disease involving a sudden interruption in the arterial blood supply to a tissue, organ, or extremity?
Acute Arterial Occlusion
If left untreated, Acute Arterial Occlusion can lead to
Three causes of Acute Arterial Occlusion
Thrombosis of an atherosclerosis artery
Six Ps of AAO:
Treatments for AAO:
Inflammation and thrombosis of superficial veins that presents as a painful induration with erythema
Side effects include fever, redness, swelling, or pain in area of clot,Skin feels hot or warm, send me feel tender or hard like a cord, worm like vein seen just under the skin
How to diagnose superficial thrombophlebitis
How to treat superficial thrombophlebitis
Antibiotics, NSAIDS, anticoagulation, surgery
How to treat DVT
How to diagnose DVT
D-dimer + Doppler ultrasound
Most common place for clots
Popliteal and superficial femoral
How often do clots occur in the common femoral?
Veins cannot pump enough oxygen-poor blood back to the heart d/t incompetent valves in lower extremities
Chronic venous insufficiency
When chronic venous insufficiency occurs post-DVT, it’s called
Besides DVT, chronic venous insufficiency May occur after
Main risks of chronic venous insufficiency
Cellulitis + ulcers
Treatments include manual compression lymphatic massage therapy, sequential compression pump, ankle pumps, compression stockings, blood pressure medicine
Chronic venous insufficiency
Surgeries for chronic venous insufficiency
subfascial endoscopic perforator vein surgery
Leaflets of valves no longer meet properly, valves become incompetent
AV fistulas are created for
What causes carotid stenosis?
Common site for atherosclerosis?
Bifurcation if common carotid artery
How to diagnose carotid stenosis
Carotid bruits on exam, then by color flow duplex ultrasound scan of carotid arteries
Major treatment for carotid stenosis?
Initiating event of aortic aneurysm
Tear in intima of vessel wall, blood flows in, separates intima + adventitia
Main cause of aortic aneurysm
Older males are more prone to
Risk of rupture in aneurysm greater than 5 cm in a 5 year period is
Symptoms of aortic aneurysm rupture
Chest, abdominal, back pain
HTN followed by hypotension
Patient in shock
Placement of endovascular stent via percutaneous technique through femoral arteries into diseased portions of aorta
Aortic aneurysm endovascular treatment
Why must you monitor pressure in right arm in patient with aortic aneurysms?
Aortic cross clamp is just distal to left subclavian artery; Occlusion of sorts will prevent BP monitoring in left arm
Where should MAPS be maintained above cross clamp in aortic aneurysm surgery?
Where should MAPS be distal to cross-clamp in aortic aneurysm repair?
You want to make sure perfusion is maintained in aortic aneurysm patient, especially to
Kidneys and spinal cord
Neuro protecting during aortic aneurysm case?
Spinal cooling and drainage
What can SSEP/EEG monitor during aortic aneurysm case?
What does TEE assess during aortic aneurysm case? Use with what as adjunct?
Aortic atherosclerosis and valve function ; PA catheter as adjunct
What medication before cross-clamping in aortic aneurysm case?
Mannitol improves renal cortical blood flow + GFR