PCM1: Pulses Exam

=Pulse & Blood Vessel - Exam Checklist=

PURPOSE
To examine blood flow in periphery, suspicion of peripheral heart, occluded artery, heart disease. May be coupled with heart exam, vitals (eg: blood pressure, respirations, etc)

Introduction & Focused History

 * CC
 * Leg pain, Cramping, numbness: OPQRST
 * Dizziness, headaches, swollen ankles: OPQRST
 * History of heart disease, hypertension, diabetes
 * MEDS
 * SHx: work, tobacco, EtOH, drugs, exercise
 * (Family history of heart disease, etc)
 * (Surgical history)

EXAMINATION ORDER

 * INSPECTION: general, coloration, cyanosis @ distal digits, bounding, edema, varicose veins
 * AUSCULTATE: bell for carotid bruit (do not palpate carotid w/bruit)
 * PERCUSS: N/A


 * PALPATE:
 * Pulses: carotid, brachial, radial, femoral, popliteal, dorsalis pedis, posterior tibialis
 * Temperature
 * Pitting edema

Potential difficulty

 * Gowning and dress: ensure patient uncovers everything you need to examine before starting
 * Gently examine carotid first or listen with bell of stethoscope while patient holds their breath. Ask patient to hold breath while auscultating.
 * Symmetry is important. Check both sides and proceed logically.

DATA

 * Presence/strength of pulse at each area, symmetry.
 * 4: bounding, 3: full, increase, 2: expected, 1: barely palpable, 0: none
 * Bruits
 * Pulse rate. Count 30 seconds.
 * Regularity/rhythm of pulse (alternating, regularly irregular, irregularly irregular, regular)
 * General color, temperature
 * Pitting (1-4: 1 slight pitting to 4 very deep pitting that lasts 2 mins)