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29 Cards in this Set
- Front
- Back
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USUALLY THE HIGHER OF THE TWO PEDAL DOPPLER PRESSURES IS USED TO obtain the remainder of the segmental pressures inthe leg beginning with the calf level |
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*things to rember about segmenal bl pressures
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COMPLETE CESSATIONOF BL FLOW IS REQUIRED;CUFFS INFLATED 20-30 mmHg BEYOND LAST AUDIBLE DOPPLER ARTERIAL SIGNAL OR; INFLATE THE CUFF 20-30 HIGHER THAN THE HIGHEST BRACHIAL PRESSURE |
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*what to do if pressure messurements need to be repeated |
the cuff should be fully deflated for about a min prior to repeat inflation
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*when is the systolic pressure recorded
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pressure at which the first audible doppler arterial signal returns
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ankle/brachial index (ABI) is calculated
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by dividing the ankle pressre by the higher of the two brachial pressures aka: ankle/arm index (API) |
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*normal ABI
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greater than 1.0
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** what is the range of ABI that shows claudication (moderate disease)
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0.5-0.9 |
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what is the range of ABI that shows asymptomatic disease or mild arterial disease
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greater than 0.9-1.0
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what is the range of ABI that is equal to at rest pain (severe arterial disease)
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less than 0.5
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incompressible vessels have what effect on pressure taking
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they have falsely elevated and inaccurate pressures. an ABI of greater than 1.3-1.5 is considered incompressible
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** what range of pressure drops between two consecutive levels suggest significant obstruction (LE)
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greater than 30mmHg (some authors suggest 20-30 mmHg) |
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**what range of pressure drops suggest obstr disease at or above the level int he leg with the lower pressure
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greater than or equal to 20-30 mmHg
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see top of pg 41 for examples of pressure readings in legs
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pressures using 4 cuff technique in LE
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THE HIGH THIGH PRESSURE IS NORMALLY EQUAL TO OR GREATER THAN 30mmHg THAN HIGHEST BRACHIAL PRESSURE. THE AK AND BK PRESSURES SHOULD BE AT LEAST THE SAME AS THE HIGHEST BRACHIAL |
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PRESSURES USING 3 CUFF TECHNIQUE IN LE |
THIGH PRSSURE IS SIMILAR TO THE HIGHEST BRACHIAL PRESSURE DOES NOT ALLOW FOR DIFFERENTIATION OF HT AT AK PRESSURES |
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pressure levels for foot ulcer healing |
toe pressures of less than or equal to 30mmHg are evident in foot and toe ulcers that failed to heal. ankle pressures cannot always be relied upon in diabetic pts so the toe pressures are used |
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comparing values at rest to after exercise
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helps differentiate between true and pseudo-claudication determine presence/absence of collaterals ** contraindications include: shortness of breath, htn, cardiac issues, stroke, walking problems |
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technique of after resting exam (LE)
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pt walks on a constant load treadmill at * less than or equal to 12% elevation at a speed of 1.5 MPH for a max of 5MIN or until symptoms increase tos uch severity that pt must stop. document durationof walking, MPH, onset, location and progression of symptoms |
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post exercise doppler pressures obtained (LE)
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both ankles are (abnormal first), then higher brachial
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*post excercise ABI obtained
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-**immediately (normal: ABI increases) - abnormally, ABI decreases minimally or to severe amount. - with drop after exercise, pressures obtained every two min until pre-excercise pressures ar attained.
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interpretation of pressures with excercise (LE)
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incorporates: duration of excercise length of time to recover pressure changes from pre to post exercise |
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single level disease (pressure reading with excercise)
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TAKES 2-3 MIN FOR THE ABI'S TO INCREASE BACK TO RESTING LEVELS AFTER THEY DROPPED TO LOW OR UNRECORDABLE LEVELS AFTER EXERCISE
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multi-level disease (pressure reading wtih excercise)
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TAKES FROM 6-12 MIN FOR THE ABI'S TO INCREASE BACK TO RESTING LEVELS AFTER THEY REMAINED LOW OR AT UNRECORDABLE LEVELS AFTER EXCERCISE.
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reactive hyperemia
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an alternate method for stressing the peripheral circulation. USED WHEN PT CANNOT WALK LONG ENOUGH, USE CANE OR WALKER, HAVE LUNG ISSUES;POOR CARDIAC STATUS, OR OTHER SITUATIONS.
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METHOD OF PRESSURE TAKING WITH REACTIVE HYPEREMIA
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bialteral thigh cuffs (19x40) inflated to suprasystolic pressre levels (USUALLY 20-30 mmHg ABOVE THE HIGHER BRACHIAL BP) MAINTAINING THE PRESSURE 3-5MIN upon release of cuff occlusion, ABI's are obtained. NORMAL LIMBS MAY SHOW A TRANSIENT DROP OF 17-34% PRODUCES ISCHEMIA AND VASODILATATION DISTAL TO THE OCCLUSING CUFFS. |
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SINGLE LEVEL DISEASE (REACTIVE HYPEREMIA) |
LESS THAN OR EQUAL TO 50% DROP in ankle pressure with reactive hyperemia
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MULTI-LEVEL DISEASE (REACTIVE HYPEREMIA)
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LESS THAN 50% ANKLE PRESSURE DROP IS SEEN
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why is treadmill testing is the preferable test |
because it produces a physiologic stress that reproduces a pt's ischemic symptom
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