Pedal Pulses and Peripheral Vascular Diseases
Posted by Laura on May 9, 2010
From allnurses.com: According to Textbook of Physical Diagnosis: History and Examination, 3rd edition, by Mark H. Swartz, M.D., page 329 “The dorsalis pedis pulse is best felt by dorsiflexion of the foot. The dorsalis pedis artery passes along a line from the extensor retinaculum of the ankle to a point just lateral to the extensor tendon of the great toe.”
http://medicine.ucsd.edu/clinicalmed/extremities.htm – if you scroll down this page to the section near the end entitled The Distal Pulses you will find a discussion and photos (one anatomical from a cadaver) on how to locate and palpate the Dorsalis Pedis Pulse in the foot.
Some additional information for you, in the event that the subject of the “grading”, or amplitude, of pulses should come up. Here is the most popular grading scale that is used (page 330 of the Swartz textbook):
0 – absent
1 – diminished
2 – normal
3 – increased
4 – bounding
If your patient has Pain, Pallor, Pulselessness, Paresthesia, Paralysis (and you could go 6 with Poikilothermia – coldness) – You have a good chance they have an Arterial Embolism.
Check their pedal pulses every 2 hrs after surgery to be sure there is no occlusion.
ABI – ration systolic of ankle to arm.
Take systolic of each foot. Systolic of each arm(brachial). Divide each foot’s systolic with the highest arm’s systolic.
- Your ABI will be normal if it = 1.0
- Claudication = 0.95 – 0.50
- Ischemic rest pain ABI = < 0.50
- (ischemic – no blood flow to tissues)
Treatment of claudication: Trental pentoxifylline & clopidogrel Pletal. Trental to increase RBC flexibility and decrease fibrinogen concentrations. Pletal to inhibit phosphodiesterase III and vasodilate – not to treat the claudication.
Treatment for Arterial Embolism – Heparin w/inital bolus of 5,000 to 10,000 units followed by continuous drip at 1000 units per hour to prevent further embolism. What treats Heparin? Protamine Sulfate!
Aspirin – prevents the formation of thromboemboli. Plavix for prevention of cardiovascular ischemic events w/PAD
Aneurism = Diastolic BP >100, Surgery > 2″ or 5.5cm.
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