As we know in medicine, water is not gravity-friendly and often collects in the limbs, resulting in bilateral edema that can be very painful. As mentioned earlier, any type of trauma to a dependent limb can complicate the assessment of a pedal pulse. Due diligence should be performed when assessing circulation in the case of a traumatic leg injury. When the body shunts blood to the core, peripheral circulation is affected. Pulses might be faint or absent depending on the length of time and temperature exposure.
Any type of shock that affects central circulation brings the potential for weak or absent peripheral pulses. This includes mechanical cardiogenic , hypovolemic, neurogenic spinal , and systemic shocks anaphylactic and septic. Fortunately, there are other techniques besides pedal pulses to determine peripheral circulation. Sight: How does the limb present? Is it blue, pale, mottled, or normal in color? Is it attached or partially amputated? Is it in normal alignment, or does it look out of alignment?
Touch: How does the foot feel? Is it cold or warm? When you press down does the skin blanch cap refill assessment and immediately return to normal? Or is there a delay to return of normal coloring in the formally blanched area? A delayed cap fill can indicate perfusion concerns and should be used in conjunction with a thorough patient exam and history.
When assessing cap refill on a foot, you can use the nail beds or heel. However, a cap refill can be used on all aspects of the foot. Listen: Listen to what your patient is saying about their foot. Is it tingling? Pins and needles? All of these complaints indicate a circulation check yes, that means the sock has to come off. A thorough patient assessment and gathering of history helps determine a proper treatment plan. This involves any type of medical intervention, immobilization techniques, and method of extrication.
When assessments are performed correctly, we learn how to work smarter, not harder. Stay safe out there! Sign in. EMS World Expo. Current Issue. Issue Archives. Start Print Subscription. Renew Print Subscription. Start Digital Subscription. Patient Care. Expo on Demand. Professional Reference articles are designed for health professionals to use.
You may find one of our health articles more useful. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. It is very easy to overlook the art of clinical examination when new technology can so easily be employed to make diagnoses.
Systematic cardiovascular examination can provide a diagnosis quickly without need for invasive or expensive tests. Such routine examination can reveal an unexpected and timely diagnosis.
Historically, in the Middle or Far East, doctors were expected to make many diagnoses on examination of the radial pulse alone. Still today, thorough examination of the pulse can provide a lot of information and help form an accurate diagnosis.
It is important to develop a reliable routine for examining the pulse and to refine and improve the technique throughout a career. As with all clinical examination, there are aspects of the history which are particularly relevant to abnormalities in the pulse.
There are many symptoms which may be relevant; however, some examples include:. Arterial pulses can be examined at various sites around the body. Systematic examination normally involves palpating in turn radial, brachial, carotid, femoral and other distal pulses. Palpation of the abdominal aorta would also form part of this systematic examination to identify abdominal aortic aneurysms for example.
Other sites may be examined for pulses, in special circumstances - for example, the temporal artery for tenderness in temporal arteritis and the ulnar artery if the radial cannot be felt or before arterial access at the radial site.
Finally, note the character of the pulse. This incorporates an assessment of the pulse volume the movement imparted to the finger by the pulse and what has been described as the 'form of the pulse wave'. The pulse character must be interpreted in the light of pulse rate. Studies have correlated markers of arterial stiffness eg, pulse-wave velocity and pulse pressure with risk for the development of fatal and non-fatal cardiovascular events [ 3 , 4 ].
This systematic examination of the pulse will give a great deal of information. Systematic examination of the pulse remains an essential part of clinical practice. Disorders of blood inflow arterial and outflow venous have different associated signs and symptoms based on their varying pathophysiology see above.
Edema is commonly associated with venous insufficiency, a blood return problem. This disorder tends to get worse when the legs are allowed to dangle for prolonged periods below the level of the heart e.
The fluid builds up preferentially in the most distal aspects of the leg and progress up towards the knee as the process worsens. Arterial insufficiency, on the other hand, rarely causes edema, which makes perfect sense as the problem lies in the delivery of blood to the extremity, not the return from it.
On occasion, the conditions may coexist. It may be difficult to detect small amounts of fluid. Look around the malleoli, as fluid will cause a loss of the normally distinct appearing edges of the bone.
Similarly, fluid will tend to "fill in" the spaces between the extensor tendons on the top of the foot, causing them to appear less defined. If you're not sure whether fluid is present, push on the area for several seconds, release, and then gently rub your finger over that same spot, feeling for the presence of a "divot," referred to as pitting.
Femoral pulse - The femoral pulse is palpated over the ventral thigh between the pubic symphysis and anterior superior iliac spine with the middle and index fingers.
Popliteal pulse - The popliteal pulse is palpated on the posterior knee with the middle and index fingers; this pulse is more difficult to palpate as compared to other pulse sites.
Posterior tibial pulse - The posterior tibial pulse is palpated posterior and inferior to the medial malleolus by gently pressing the tibial artery against the underlying bone with the middle and index fingers.
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