PHYSICAL EXAM MODULES by hbaKk15

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									3rd Year Medical Student Surgery Clerkship
VASCULAR EXAMINATION MODULE


Goals
        • establish presence and quality of pulses
        • establish presence or absence of aneurysms
        • establish presence or absence of arterial bruit
        • establish presence or absence of arterial disease
        • establish presence or absence of venous disease



Methods

1. Discuss what you are about to do:
       inform patient of intention of examination
       explain how exam will be conducted

2. Prepare your patient for examination:
       be sure room temperature is correct
       be sure limb position is as needed
       be sure privacy is respected
       place patient in correct position: supine on exam table is generally best
       uncover area to be examined

3. Prepare yourself for the exam:
       approach exam systematically
       compare bilaterally
       review patient complaints as exam progresses

4. Follow exam sequence:
       observe
       auscultate
       lightly touch
       palpate
       compress
Specific Observations
Vascular Examination


1. Pulses -- should note 17 pulses.
       -- quality (-, +, ++)
       -- Superficial Temporal x2, Common Carotid x2, Brachial x2, Radial x2, Aorta x1,
          Common Femoral x2, Popliteal x2, Dorsalis Pedis x2, Posterior Tibialis x2.

2. Aneurysms
      -- should note presence of at least 5 aneurysms.
      -- Aorta x1, Common Femoral x2, Popliteal x2.

3. Bruit
       -- should note presence of at least 5 bruit.
       -- Common Carotid x2, Aorta x1, Common Femoral x2,

4. Ischemic Signs -- signs of arterial disease.
       -- should note presence of at least 6 Ischemic Signs for each limb.
       -- Color, Temperature, Capillary Refill, Ulceration, Eschar, Location

5. Venous Signs -- signs of venous disease.
      -- should note presence of at least 5 Venous Signs for each limb.
      -- Brawny Color, Varicose Veins, Ulceration, Edema, Location



Evidence Testing:

In a second brief exam --use specific complaint to target examination.

Scenario #1:   Patient complains of calf claudication
Scenario #2:   Patient complains of thigh claudication
Scenario #3:   Patient complains of buttock claudication
Scenario #4:   Patient complains of leg swelling
Scenario #5:   Patient complains of cold feet
Scenario #6:   Patient complains of pulsatile mass in abdomen
Student Worksheet -- Specific Observations
Vascular Examination

1. Pulses -- should note quality (-, +, ++)
       right left
       _____ _____ Superficial Temporal
       _____ _____ Common Carotid
       _____ _____ Brachial
       _____ _____ Radial
              _____ Aorta
       _____ _____ Common Femoral
       _____ _____ Popliteal
       _____ _____ Dorsalis Pedis
       _____ _____ Posterior Tibialis


2. Aneurysms (yes, no)
      right left
            _____ Aorta
      _____ _____ Common Femoral
      _____ _____ Popliteal


3. Bruit (yes, no)
       right left
       _____ _____ Common Carotid
               _____ Aorta
       _____ _____ Common Femoral


4. Ischemic Signs -- signs of arterial disease. (normal, abnormal; yes, no; If yes, location)
       right left
       _____ _____ Color
       _____ _____ Temperature
       _____ _____ Capillary Refill
       _____ _____ Ulceration
       _____ _____ Eschar
                     Location ___________________________


5. Venous Signs -- signs of venous disease. (yes, no. If yes, location)
      right left
      _____ _____ Brawny Color
      _____ _____ Varicose Veins
      _____ _____ Ulceration
      _____ _____ Edema
                    Location ___________________________
Evaluation Worksheet
Vascular Examination                                                Date:


Student Name:



Did the student examine and record the following?

      YES NO
      _____ _____ 17 pulses
      _____ _____ 5 aneurysms
      _____ _____ 5 bruit
      _____ _____ 6 sings of arterial disease
      _____ _____ 5 signs of venous disease

      _____ _____ explain examination procedure
      _____ _____ position patient correctly
      _____ _____ uncover the skin of the part to be examined.
      _____ _____ inspect
      _____ _____ auscultate with stethoscope on skin
      _____ _____ touch skin (no through clothing or dressing)
      _____ _____ palpate for aortic aneurysm between umbilicus and xyphoid
      _____ _____ palpate for popliteal pulse or aneurysm with two hands
      _____ _____ stand at foot of patient while palpating dorsalis pedis and posterior tibial
      _____ _____ compress ankle to assess edema
      _____ _____ feel toes to asses temperature
      _____ _____ press toes to asses refill


Totals: _____      _____
3rd Year Medical Student Surgery Clerkship
Vascular Examination



Pre- Test

1.    How many pulses should be noted in the complete vascular examination?

2.    What is capillary refill?

3.    How is brawny edema different from pitting edema?

4.    What color is venous pigmentation?

5.    Where on abdomen is an aortic aneurysm palpated?

6.    What causes arterial bruit?

7.    Should popliteal pulses be palpated with one or two hands?

8.    Where are arterial ulcers located?

9.    Where are venous ulcers located?

10.   What is the significance of a carotid bruit?

								
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