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In medicine, the peripheral vascular examination is a series of maneuvers to elicit signs of peripheral vascular pathology. Position - patient should be lying in the supine position and the bed or examination table should be flat.
Pitting edema - should be tested for in dependent locations - dorsum of foot, if present then on the shins. Venous refill with dependency (should be less than 30 seconds) - the vein should bulge outward with in 30 seconds of elevation for one minute. Begin by simply looking at the area in question, which is on either side of the crease separating the leg from the groin region. The femoral pulse should be easily identifiable, located along the crease midway between the pubic bone and the anterior iliac crest.
A femoral hernia, if present, is located on the anterior thigh, medial to the femoral artery. Place your hands around the knee and push the tips of your fingers into the popliteal fossa in an effort to feel the popliteal pulse. The bottom of the foot and between the toes: These are common "problem areas," particularly in patients with diabetes who are predisposed as a result of sensory impairment, arterial insufficiency, or both. If there is a lot of edema, you will have to push your way through the fluid-filled tissue to get down to the level of the artery. If you are unable to palpate a pulse, find a doppler machine, which should be present on any inpatient floor or ER, and use it to identify the location of the artery. Located just lateral to the extensor tendon of the big toe, which can be identified by asking the patient to flex their toe while you provide resistance to this movement.



With the patient supine, empty the superficial veins by 'milking' the leg in the distal to proximal direction. Over time, long standing stasis of blood leads to the deposition of hemosiderin, giving the skin a dark, speckled appearance. As with edema, this is very subjective and it will take you a while to develop a sense of relative values. It can be palpated by scooping the patient's heel in your hand and wrapping your fingers around so that the tips come to rest on the appropriate area. Gently place the tips of your 2nd, 3rd and 4th fingers adjacent to the tendon and try to feel the pulse. If you feel any lymph nodes, note if they are firm or soft, fixed in position or freely mobile (fixed, firm nodes are more worrisome for pathologic states). This artery is covered by a lot of tissue and can be difficult to identify, so you may need to push pretty hard. In this way, you will be able to determine if the vessel was not palpable on the basis of limited blood flow or if you are simply having a "technical" problem.
In the event that the pulse is not palpable, the doppler signal generated is also rated, ranging again from 0 to 2+.
Alternatively, you can reach your fingers over the top of the medial malleolous and approach the artery from this direction. Interstitial space is the extravascular compartment of the extracellular fluid and surrounds the cells of a given tissue. Even then, it may not be palpable, which is not clinically important if you can still identify the more distal pulses.


This occurs as a result of gravity working against an already ineffective blood return system. Patients with severe arterial insufficiency, on the other hand, may have relatively pale skin as a result of under perfusion.
Palpating the patients radial artery or your own carotid simultaneously with your free hand can help sort this out. Further reading about basics of fluid compartment and fluid therapy: Basics of fluid therapy. When their legs are placed in a dependent position, gravity enhances arterial inflow and the skin may become more red as maximally dilated arterioles attempt to bring blood to otherwise starved tissues.
In cases of severe ischemia, the affected areas (usually involving the most distal aspect of the foot), can appear whitish or mottled, giving the leg a marbleized appearance.
In myxedema, there is infiltrative edema with deposition of mucinous materials under the skin. Learning is not memorizing but conceptualizing.Epomedicine also provides quick access to case discussion on interesting medical cases, videos for developing correct clinical skills and a blog to go beyond notes and research articles to explore the inner-self of medical students and healthcare professionals.




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