PAIN 2 PALLOR 3 PULSELESSNESS 4 PARALYSIS 5 PARESTHESIA 3 4 and 5 suggest

Pain 2 pallor 3 pulselessness 4 paralysis 5

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PAIN 2. PALLOR 3. PULSELESSNESS 4. PARALYSIS 5. PARESTHESIA 3, 4 and 5 suggest surgical emergency
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Clinical Presentation Asymptomatic : Without obvious symptomatic complaint (but usually with a functional impairment). Classic Intermittent Claudication : Lower extremity symptoms confined to the muscles with a consistent (reproducible) onset with exercise and relief with rest. Atypical” leg pain : Lower extremity discomfort that is exertional, but that does not consistently resolve with rest, consistently limit exercise at a reproducible distance
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Differential Diagnosis of Intermittent Claudication Intermittent Claudication Venous Claudication Neurogenic Claudication Quality of pain Cramping "Bursting" Electric shock-like Onset Gradual, consistent Gradual, can be immediate Can be immediate, inconsistent Relieved by Standing still Elevation of leg Sitting down, bending forward Location Muscle groups (buttock, thigh, calf) Whole leg Poorly localized, can affect whole leg Legs affected Usually one Usually one Often both
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Arterial vs Venous symptoms Arterial Venous Pain Intermittent claudication, may progress to pain at rest Chronic, dull aching pain which progresses throughout the day Color Pale to dependent rubor, dull to bright reddish color Normal to cyanotic Skin temperature Takes on environmental temperature, cool Normal Pulses Diminished to absent Normal but difficult to palpate due to edema Edema Not present with isolated PAD Present, can be pitting. Can have weeping of serous fluid Tissue changes Skin is shiny with hair loss. Trophic changes in nails, muscle wasting Stasis dermatitis with flaky dry and scaly skin. Can have brownish discoloration. Fibrosis with narrowing of the lower legs (“bottle legs”) Wounds Occur distally especially at toes and web spaces. May develop gangrene and tissue loss Shallow ulcers on the foot and ankle, usually medially
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How is PVD diagnosed? Ankle-Brachial Index Test (ABI) The blood pressure in your arms and ankles is checked using a regular blood pressure cuff and a special ultrasound stethoscope called a Doppler. The pressure in your ankle is compared to the pressure in your arm to determine how well your blood is flowing. The index is determined by dividing ankle systolic BP by arm systolic BP.
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Calculation of ABI To calculate the ABI: Divide the highest ankle systolic pressure with the highest brachial pressure for the index. AHA ABI INTERPRETATION: >1.3 Noncompressible arteries 1.00-1.29 Normal 0.91-0.99 Borderline (equivocal) 0.41-0.90 Mild-to-moderate PAD 00.00-0.40 Severe PAD (Borrero, 2009)
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Diagnostics and Lab W/U CBC, Chem Profile EKG- r/o cardiac abnormalities Inflammatory blood markers- D Dimer, homocysteine, CRP, interleukin 6
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Imaging Studies Doppler studies –though not 100% reliable emboli may still be present as a result of collateral circulation distally MRI CT Angiography
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Pharmacological Agents-Meds Drugs that lower cholesterol & control high blood pressure.
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