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 (-, +, ++)
rightleft
______Superficial Temporal
______Common Carotid
______Brachial
______Radial
_____Aorta
______Common Femoral
______Popliteal
______Dorsalis Pedis
______Posterior Tibialis
2. Aneurysms (yes, no)
rightleft
_____Aorta
______Common Femoral
______Popliteal
3. Bruit (yes, no)
rightleft
______Common Carotid
_____Aorta
______Common Femoral
4. Ischemic Signs -- signs of arterial disease. (normal, abnormal; yes, no; If yes, location)
rightleft
______Color
______Temperature
______Capillary Refill
______Ulceration
______Eschar
Location ______
5. Venous Signs -- signs of venous disease. (yes, no. If yes, location)
rightleft
______Brawny Color
______Varicose Veins
______Ulceration
______Edema
Location ______
Evaluation Worksheet
Vascular ExaminationDate:
Student Name:
Did the student examine and record the following?
YESNO
______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?