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:
Scenario #2:
Scenario #3:
Scenario #4:
Scenario #5:
Scenario #6:
Patient complains of calf claudication
Patient complains of thigh claudication
Patient complains of buttock claudication
Patient complains of leg swelling
Patient complains of cold feet
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?