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Peripheral Vascular Exam - OSCE Guides

Peripheral Vascular Exam - OSCE Guides

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Published by Phil Neill
Quick guides for peripheral arterial, DVT and varicose vein examinations. From the Peer Assisted Learning team at Manchester University.
Quick guides for peripheral arterial, DVT and varicose vein examinations. From the Peer Assisted Learning team at Manchester University.

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Categories:Topics, Art & Design
Published by: Phil Neill on Dec 05, 2008
Copyright:Attribution Non-commercial No-derivs

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06/01/2012

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1. Introduction
Wash Hands
Introduce yourself, explain & gain consent
Check patient ID
Is the exam general or focused?
2. General Inspection
Is the patient well at rest?Check for clues around the bed
Mobility aids
O2
Cigarettes
Medications eg. GTNPatient
Age
Signs of heart failure
Cyanosis/Pallor
3. Hands
Temperature
Tar Staining
Capillary Refill
Tendon / Palmarxanthoma
Radial Pulse (Rate, Rhythm, Character)
BP in
both 
arms
4. Face
EYES
Xanthelasma
Corneal Arcus
ConjunctivalPallor
MOUTH
Central Cyanosis
Angular Stomatitis
* Carotid Pulse
5. Abdomen
INSPECTION
Obvious pulsatations
Masses
Scars
PALPATION
(Ask about any pain first)
Pulsatilemass(Progressively deeper palpation abovethe umbilicus)
Expansilemass(Progressively deeper palpationboth hands either side of the umbilicus)
6. Leg Inspection
Comparing right to left
Dressings
Scars
Discolouration
Pallor
Missing hair / nails / toes
Ulcers
Non-healing injuries around pressurepoints
Dry Skin
Look in between toes and lift up feet
Ask the patient to wiggle their toes(Motor dysfunction in acute ischaemia)
7. Leg Palpation
( Work distal to proximal)
Temperature: Compare both legs using the back of one hand
Sensation: Get the patient to close their eyes while testing
Capillary refill: Squeeze both big toes for 3-5 seconds & release(Normal = less than or equal to 2 seconds)
Pulses: Normal / Absent / Reduced
8. Auscultation
Femoral
Aortic
Renal
Carotids
9. To Finish
Thank patient
Ask if they have any furtherquestions
Allow them to redress in private
Further tests & investigations
Peripheral Arterial DiseaseExamination
 
 
1. Introduction
Wash Hands!
Introduction
Check pt name and ID
Explain & Gain consent
2. General Inspection
Look around the bed for:
Wheelchair / walking aidsLook at patient for:
Fractures
Signs of surgery and injury
Pregnancy
GTN spray
Is patient breathless
3. Leg Inspection(compare both legs)
Redness
Swelling (you would expectthese in DVT)
Varicose veins
Ulceration
Missing digits
4. Leg Palpation(compare both legs)
Temperature (use back ofhand)
Tenderness
Pitting Oedema
Pulses (refer to arterial notes)
5. Measure
Use the measuring tape provided
Mid calf, 10cm below tibialtuberosity
Compare both legs at the SAMEpoint
If >3cm difference
significantfor DVT scoring
6. Auscultation
Lung basesFor any signs of PE(reduced breath sounds heard)
7. To finish
Thank patient
Cover him up
Mention investigations
Things to note for OSCE discussion:1. Possible Differentials
Cellulitis
Ruptured Baker’s Cyst
Lymphoedema
Compartment Syndrome
2. Further Investigations
Wells’ Score: if low, perform D-Dimer
Bloods (FBC, U+Es, clotting)
Duplex Scanning (USS + Doppler)
Venogram
DVT Examination

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Nirmal Dey added this note
Thanks, pl. notify me every time such a helpful guideline
Nazir Ahmed Wani added this note
excellent presentation
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