Examining the Peripheral Pulses

Retinal Carotids Brachial Renal Ulnar Radial Femoral Popliteal Posterior Tibial Dorsal Pedis

Examination of Pulses Grading: Trophic changes/Ulceration Perfusion Normal/Increased/Decreased/Absent 2+/3+/1+/0 Allen’s test Trophic changes/Ulceration Perfusion Pallor on elevation Rubor on dependency Venous refill with dependency (should be less than 30 seconds) Bruits

Trophic Changes Shiny, hairless skin, dystrophic nail changes and dependent rubor associated with peripheral arterial occlusive disease of the patient's right foot

Pallor on elevation Rubor on dependency

Digital Ischaemia Gangrene

A Practical Guide to Clinical Medicine - UCSD Acute Arterial Insufficiency: Mottled Appearance of Skin Chronic Arterial Insufficiency with Ulcers http://medicine.ucsd.edu/clinicalmed/extremities.htm

Measurement of the Ankle-Brachial Index (ABI) Figure 1. Measurement of the Ankle-Brachial Index (ABI). Systolic blood pressure is measured by Doppler ultrasonography in each arm and in the dorsalis pedis (DP) and posterior tibial (PT) arteries in each ankle. The higher of the two arm pressures is selected, as is the higher of the two pressures in each ankle. The right and left ankle-brachial index values are determined by dividing the higher ankle pressure in each leg by the higher arm pressure.16 The ranges of the ankle-brachial index values are shown, with a ratio greater than 1.30 suggesting a noncompressible, calcified vessel. In this condition, the true pressure at that location cannot be obtained, and additional tests are required to diagnose peripheral arterial disease. Patients with claudication typically have ankle-brachial index values ranging from 0.41 to 0.90, and those with critical leg ischemia have values of 0.40 or less. Hiatt W. N Engl J Med 2001;344:1608-1621

Venous Abnormalities Varices

Spider Veins

Venous Insufficiency

Stasis Dermatitis/Ulceration

Edema

Cellulitis vs DVT Cellulitis Right Deep Venous Thrombosis