PERIPHERAL VASCULAR EXAM

Introduction

Knock, enter the room, wash/sanitize hands and introduce yourself as a medical student
Greet the patient, ask the patient’s name, explain the exam and ask for consent
Always take vitals before a physical exam (In an OSCE the vitals will be provided, so ask for vitals aloud)
Advise and request patient to drape according to the exam being performed (mention what type of exposure is necessary)

Acronym – CHUSE	PERIPHERAL ARTERIAL DISEASE	PERIPHERAL VENOUS DISEASE
Colour	Pallor	Brown, Blue, Purple
Hair	Loss	No Change
Ulceration	Pressure Points- soles, ventral surface of foot	Tibial Plateau, Medial Malleolus
Skin	Shiny	Flaky
Edema	N/A	Peripheral Edema

Using the bell of your stethoscope, listen to the carotid, abdominal aorta, renal, iliac and femoral arteries for signs of turbulent blood flow

Palpate dorsal surfaces of feet with back of hand to assess for temperature
- Cold feet are a sign of arterial deficiency
- Warm feet are a sign of venous deficiency
Palpate bilaterally for peripheral pulses: Dorsalis Pedis, Posterior Tibial, Popliteal, Femoral
- Report the grade of pulses
Palpate bilaterally for central pulses: Carotid, Brachial, Radial, Abdominal Aorta, Renal and Iliac
- Report the grade of pulses
Palpate for capillary refill time by asking patients to raise arm to level of their heart
- Press down on the nail bed, and measure time for blood to return (check time with other hand)
- Report capillary refill time
Palpate for pitting edema in the lower legs and provide grade if present.
- If positive, assess upper legs, arms and face for edema.
Assess the calf circumference for size and symmetry between calves
- Report difference
- Should be less than 3 cm