ABSTRACT
Exposes legs adequately Asks whether patient is in pain Inspects for ischaemic skin changes, ulcers and surgical scars (looks especially for ulcers on the tips of the toes and around the heels) Assesses the temperature of both legs Checks for capillary refilling time Feels for pulses: abdominal aorta, femoral, popliteal, posterior tibial and dorsalis pedis Auscultates for bruits (femoral and popliteal) Assesses for venous guttering (elevates the leg to approximately 15°) Checks Buerger’s angle (this is the angle at which the leg becomes pale) Performs Buerger’s test (after checking Buerger’s angle, asks the patient to hang his legs over the side of the bed – looks for reactive hyperaemia) States intention to examine the rest of the peripheral vascular system States intention to examine the cardiovascular system States intention to perform an ankle-brachial pressure index (ABPI) reading using a hand-held Doppler
Cleans hands by washing or using alcohol gel
Fluency of examination Competence in presenting findings, summarizing and forming differential diagnoses
KEY Read the instructions to this station carefully – you may only be required to examine the legs and merely mention your intent to examine the rest, or you may have to examine the whole peripheral vascular system. If the latter is the case, palpate both radial pulses checking for radio-radial delay, check for radio-femoral delay, listen for carotid artery bruits, inspect and palpate the abdominal aorta, and finally auscultate for common iliac bruits before moving on to the leg vasculature.
