Vascular exam

Question 1

Introduction

Answer 1

1. Wash hands
2. Introduce
3. Patient details
4. Permission: Today I have been asked to perform a vascular examination - this will involve me having a look, a feel and a listen to your legs. We have our examiner here as chaperone. Does that sound okay?
5. Exposure - waist down
6. Reposition - 45 degrees
7. Any questions? Any pain?

Question 2

General inspection

Answer 2

Around the bed - walking aids
General inspection - scars, skin changes, colour, hair loss, ulcers

Question 3

Closer inspection

Answer 3

Lift legs and look at under side
Lateral side of foot, head of first metatarsal, heel, malleoli, toes and inbetween toes
If ulcer present - location, size, shape, depth, base and signs of infection (redness or discharge)

Question 4

Palpation

Answer 4

Temperature - run back of hand along both limbs, compare
Cap refill
Feel pulses bilaterally

Question 5

Pulses

Answer 5

1. Dorsalis pedis - along cleft between first 2 metatarsals
2. Posterior tibial - halfway along line between medial malleolus and heel prominence
3. Popliteal - felt behind flexed knee, fingers wrapped around
4. Femoral - midway between pubic symphysis and ASIS
5. Aorta - midline for expansile and pulsatile mass

Question 6

Auscultation

Answer 6

Listen for bruits on both sides at:
-Iliac
-Femoral
-Popliteal

Question 7

Manoeuvres

Answer 7

Buerger’s test:
1. Elevate legs to 15 degrees
2. Elevate leg further and hold
3. Then ask patient to hang legs over edge of bed
- ? Time to venous filling
- ? Reactive hyperaemia.

Question 8

To conclude

Answer 8

THANK, WASH HANDS AND STETHOSCOPE, OFFER TO HELP DRESS
To complete - full CVS and vascular examination, neuro exam, ABPI, ECG