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Introduces self
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Confirms name & age of patient
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Explains & gains consent
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Washes hands
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Exposes patient fully and asks them to lie down
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1
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Asks if patient is in pain
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1
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General inspection around bed and patient (comfortable, cyanosis,
stockings, amputations, walking aids, medication)
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Asks patient to lie down and inspects for tar staining of nails,
peripheral cyanosis, gangrene, scars
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1
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Checks capillary refill time and feels temperature of arms with back
of hand comparing both sides
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1
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Feels radial pulse for presence and radioradial delay. Offers or
performs radiofemoral delay. Feels brachial pulses
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Palpate abdominal aorta
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1
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Inspects legs for scars, colour, hair loss, shiny thin skin, loss of
subcutaneous fat, ulcers, gangrene and describes ulcers (particularly between
toes/pressure points)
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1
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Checks capillary refill time and feels temperature of legs and soles
with back of hand comparing both sides
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Palpates femoral, popliteal, posterior tibial and dorsalis pedis
pulses comparing both sides
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Auscultates over the iliac, femoral and popliteal arteries
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1
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Offers or conducts Beurger's test looking for venous guttering,
Beurger's angle and reactive hyperaemia on completion
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1
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Offers or conducts sensory examination of the lower limb
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Thanks patient and offers help to redress
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1
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Washes hands
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Requests additional arterial tests (ABPI, full cardiovascular
examination) and venous exam
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Summarises appropriately with only key findings
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Offers appropriate differential diagnoses
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Patient global score
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2
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If the station asks you to take a brief history, it is important to ask questions about current symptoms of arterial disease and assess its severity. Additionally, you could ask briefly about risk factors.
Arterial
- Leg pain (ask specifically if it occurs at rest as this is an emergency!) particularly how far this goes up
- Weakness/Numbness/Pins & Needles
- Changes to the skin
- (Erectile dysfunction - important but usually not asked)
- Risk factors: cardiovascular disease, smoking, diabetes, high cholesterol, high blood pressure