ABSTRACT
Model for a vascular history. Set the stage, Welcome the patient. Ensure comfort and privacy. Know and use the patient's name. Introduce and identify yourself. Set the agenda, Begin with open-ended questions to ascertain the patient's perspective. Encourage the consultations with silences and non-verbal and verbal cues. And focus by paraphrasing and summarising. Start the examination with the patient in supine position with a pillow under their head for support. The patient's limbs (upper and lower) and chest should be fully exposed. Ask the patient whether they have any pain. Look around bed for aids, oxygen or medication (glyceryl trinitrate [GTN] spray). Look at the patient as a whole; pain/pain free; shortness of breath, cyanosis and obesity. Skin and nails – Tar staining, clubbing, brittle nails, splinter haemorrhages, vasculitic changes, pulp atrophy, digital colour changes/cyanosis, pale palmar creases, ulceration, gangrene and amputations. Scars – Arm, neck, chest, axilla (axillobifemoral bypass grafts), abdomen (laparotomy for abdominal aortic aneurysm [AAA]).
