Checklist
Wash hands, introduce yourself, consent patient.
- OBSERVATION
- Expose limbs appropriately
- Missing limbs, toes, ulcers
- Graft scars
- HANDS
- Fingertips: capillary refill time, nicotine staining
- Warmth
- Colour
- Radial pulses and radio-radial delay
- VITALS
- NECK
- Carotid artery pulses and bruits
- ABDOMEN
- Palpate: aorta
- LEGS
- Femoral arteries – bend each knee to crease groin
- Popliteal arteries
- Posterior Tibial arteries
- Dorsalis pedis arteries
- Absence of hair, dry skin
- Feet: ulcers, capillary refill time, warmth, sensation
Omissions/Notes
ABI: ABIs are a useful, excellent tool however time consuming. In an OSCE, it should always be mentioned, however in a time pressured exam avoid going further than this. It’s frequency of use in clinic depends on the region and centre.
Femoral artery palpation: bend each leg to 90 degrees and feel in the crease of the thigh midway between the pubic symphysis and the ASIS to find the femoral pulse quickly. It is a strong pulse – if you can feel any distal pulse, it should not be absent at the crease of the thigh.
Doppler: Use the ultrasound if in clinic and you are unable to find a pulse which you suspect should be there (based on imaging/perfusion)
Investigations: Ultrasound, CTA, invasive angiogram in that order.
Resources
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