Pulse
Pulse scale:
2+
Normal
Locate artery:
Behind the knee (easier to palpate with slight knee flexion). Because of its depth within popliteal fossa, it is sometimes difficult to palpate despite sufficient circulation.
Popliteal
Painful, taut, shiny skin; thick and brittle nails; loss of hair; cold to touch; (males more than females under 70 yo)
Arterial issues
During a capillary refill test, what is the normal amount of time it takes for color to return to normal?
< 3 seconds
1. Increased capillary permeability
2. Decreased osmotic pressure of plasma proteins
3. Increased pressure in venules and capillaries
4. Obstruction to lymphatic flow
4 causes of edema
Pulse scale:
0
Absent
Locate artery:
Lies behind the medial malleolus, posterior tibialis, and flexor digitorum longus tendons
Posterior tibial artery
Not painful but thick; leathery; scaly; itchy; dry; pitting edema and normal or warm to touch
Venous
What test should not be done for DVT?
Homans sign
Assessment of pitting edema:
- slight pitting
- no visible distortion
- disappears rapidly
2 mm or less = 1+ edema
3+
Increased/full
Locate artery:
Lies between anterior tibialis and extensor digitorum longus tendons
Dorsalis pedis pulse
For arterial insufficiency testing, you will elevate the pts leg to 45 degrees for 10-15 seconds and then lower it back to original position. What would be a positive test for arterial disease?
Patient may take longer than 20-30 seconds for color to return to the foot
Testing for arterial and superficial vein insufficiency you will elevate the leg to approximately 60 degrees for a minute or until veins have been drained by gravity. Then, hang their leg over the edge of the table and note the time it takes to refill. What is a positive test for arterial insufficiency?
> 30 seconds
Assessment of pitting edema:
- pit is very deep
- lasts as long as 2-5 minutes
- dependent extremity is grossly distorted
6-8 mm = 4+ edema
pulse scale:
4+
Bounding
- Chalky white or mottles skin
- redness
- loss of hair over the digits with dry skin
Arterial issues
Testing for arterial and superficial vein insufficiency you will elevate the leg to approximately 60 degrees for a minute or until veins have been drained by gravity. Then, hang their leg over the edge of the table and note the time it takes to refill. What is a positive test for venous insufficiency?
< 5 seconds
What is the gold standard for DVT?
Well's criteria
Assessment of pitting edema:
- somewhat deeper pit
- no readily detectable distortion
- disappears in 10-15 seconds
2-4 mm = 2+ edema
pulse scale: 1+
Diminished
- cyanotic
- discoloration of the tissue (brownish) (hemosiderin stains)
Testing for arterial and superficial vein insufficiency you will elevate the leg to approximately 60 degrees for a minute or until veins have been drained by gravity. Then, hang their leg over the edge of the table and note the time it takes to refill. What is a normal refill time?
5-15 seconds
What is an alternate test for DVT?
Apply a BP cuff around the distal ankle/below calf and inflate to 40-60 mmHg. Patients with venous occlusion of some form cannot tolerate pressure > 40 mmHg
Assessment of pitting edema:
- pit is noticeably deep
- may last more than 1 minute
- dependent extremity looks fuller and swollen
4-6 mm = 3+ edema