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Partial Arterial Occlusion
leads to decreased O2 delivery to distal tissure adn tissue ischemia
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Venous return depends upon these 4 things:
skeletal muscle contraction, functional valves to prevent backflow, a patent lumen, and respirations
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What are the deep veins of the legs?
Femoral and popliteal
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What is the site for CABG-- (it is also a superficial vein of the leg)
Great Saphenous Vein
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What are perforators
Smaller veins that connect the major Veins (specifically for the legs)
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Arterial Insufficiency: Intermittent Claudication
Muscle Ischemia (often affects gastrocnemius muscle)
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Arterial Insufficiency: Smoking
Causes Vasoconstriction
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Venous Insufficiency: Swelling
- Unilateral (venous occlusion) vs. bilateral (heart failure)
- Precipitating factors: prolonged sitting/standing/travel
- Associated factors: SOB, nocturia, may be HF
- Nutritional Status: hypoalbuminemia may lead to edema
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What can venous insufficiencies cause?
Swelling, Varicose Veins, Blood Clots, Horomonal Controceptives (gives inc. risk of thrombus)
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Head and Neck pulses
temporal, carotid
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Arm pulses
brachial, radial, ulnar
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Leg pulses
femoral, popliteal, posterior tibial, dorsalis pedis
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What is the normal grade pulse?
2+
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What is a "bounding" pulse
4+
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Where do you ascultate for bruits
temporal, carotid aortic, renal, iliac, femoral
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What is the normal CRT? (capillary refill time)
less than 2 seconds
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If it takes too long to for capillary refill?
it could mean arterial occlusion, hypothermia, hypovolemic shock
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Typical changes of arterial insufficiency:
decreased or absent pulses, pallor of extremity, cool skin, thin-shiny-atropic skin, thick-ridged nails, loss of hair, ulcers & gangrene
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Does and occluded artery cause swelling?
NO!
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What are the special tests of arterial patency?
Leg Elevation, Ankle Brachial Index, Allen test
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Leg Elevation
- • With patient supine, raise the leg until it blanches
- • Then have patient sit and dangle legs (note the time of color return)
- • Arterial occlusion = delay in color return of many seconds or minutes
- • Severe disease = delay in color return of ≥ 2 minutes
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Ankle-Brachial Index
the ratio of B/P in lower legs compared to arms. A lower B/P in the leg is a sign of arterial occlusion
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Allen Test
assess patency of the radial and ulnar arteries
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Edema
Accumulation of fluid in extracellular [interstitial] spaces)
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What does pedal mean?
Foot
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What is "Anasarca" mean?
entire body
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Superficial Thrombophlebitis
Redness, thickening, tenderness along a superficial vein
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Deep Vein Thrombosis
- May be life threatening, predisposes to a pulmonary embolis.
- Pain, warmth, tenderness and swelling over a vein.
- Asymmetric calf size
- Homan's sign-- unreliable.
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5 risks for DVT
Bed Rest or immobility, Trauma, Hypercoagulable state, Varicosities, hormonal contraceptives (especially after age 35)
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Varicose Veins
dilated and swollen vessels d/t incompetent venous valves or proximal vein obstruction
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With chronic venous insufficiency, are the pulses affected?
No
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What is teh color of chronis arterial insufficiency?
Pale if elevated, bluish if dependent
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Where do you find ulcers of Arterial Insufficiency?
Lateral Malleolus
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Where do you find ulcers of venous insufficiency?
Medial Malleolus
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What is the skin like with arterial insufficiency?
Smooth, thin, shing, decreased hair, thick toenails
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