Vascular history and peripheral vascular examination
Presentation:
acute painful limb
candidate brief
actor brief
examiner brief
- Ensures does not need analgesia
- Enquires about symptoms
- trigger for pain
- how resolved
- severity, time course
- trauma
- Claudication distance
- Distribution of pain - unilateral/bilateral
- Asks for red flags for acute limb ischaemia (pulseless, paresthesia, pain, pallor, perishingly cold)
- Past medical history
- previous vascular history - previous diagnoses, interventions, meds
- Drug history and allergies
- Social history + risk factors
- States need for examination
- Suggests appropriate further investigations
examination
- Inspection of upper limbs
- peripheral cap refill
- Palpate pulses - radial, brachial
- Auscultate for carotid bruit
- Character of carotid pulse
- BP in both arms
- Inspect abdomen - scars, pulsation
- Palpate for aorta
- Auscultate for aortic bruit
- Inspect lower limbs
- hair loss, atrophy, haemosiderin deposition
- feet, toes, heels
- peripheral cap refill
- motor function
- Palpate pulses - femoral, popliteal, posterior tibial, dorsalis pedis
- Light touch sensation - start distally
- Buerger's test
- With patient supine, note Buerger's angle if present
- Pt to sit up with legs on edge of bed - Observe for dependent hyperaemia
- Further investigations: Cardiovascular o/e, ABPI
- Global mark