After this course, you should make sure that you can:

• List and describe the key peripheral arterial and venous structures
• Outline the principal properties, relations and functional interactions of these structures
• Assess their status via case history, observation and appropriate testing
• Demonstrate key psychomotor skills relevant to your examination of the above
• Apply yourself to a novel theoretical clinical situation, demonstrating a synthesis of peripheral arteriovenous knowledge and skills and testing any hypotheses you generate
• Explicitly analyse your diagnostic process, reflecting on its strengths and weaknesses
• Evaluate the bearing of these processes on your subsequent physiotherapeutic care

NB the above may be the subject of formative or summative assessment, in line with prevailing MACP guidelines


References

Visit as many of the references shown below as possible prior to your course. These are drawn from a variety of texts and take a range of forms (pictorial, textual and tabular). Our intention is to provide you with an assortment of information sources that you can choose from - and that you can match to your own learning style.

Procedure for Examination of peripheral circulation: Ref 1 pp 144-154

Digital signs: clubbing: Ref 4 pp 238-242; koilonychia: Ref 4 p 237

Specific assessment of the arterial pulses: Ref 1 pp 150-152

Example of oedema: Ref 4 p 332

Examples of Vena Caval obstruction: Ref 4 pp 304-305

Procedure for Blood Pressure assessment: Ref 1 p 152

Bring your own:

Stethoscope (preferably Littmann type)
Sphygmomanometer (preferably NOT mercury type)
Tape measure (flexible variety)
Pen torch

Indications: Palpitations or Chest Pain
Dyspnoea, Syncope or Dizziness
Oedema or Circulatory disturbance
Urinary disturbance
Unexplained Fatigue


• Structures involved
Heart, arterial and venous great vessels, peripheral vasculature and concomitant autonomic innervation to these structures. Contiguous viscera including lungs, liver, spleen and kidney.

• The cardiovascular History
The Previous medical history such as diabetes, hypercholesterolaemia
The Family History such as premature arterial heart disease, hypertension
The Social History such as cigarette smoking, alcohol and diet
Simultaneous observation for general examples such as cyanosis, breathlessness and oedema. Specific observation for examples such as finger clubbing and nicotine staining

• The Peripheral Circulation:
The major differences between arteries and veins in terms of structure and. function. The arterial pulse as indicator of both local and central integrity. Examination: a. Observation, b. Palpation, c. Auscultation, d. Comparison
Acute and chronic arterial insufficiency and venous stasis - how do these presentations compare? Differential Diagnosis between these and neurological claudication are vital.

• Blood pressure (BP):
Definitions of systolic and diastolic components
Epidemiology - Changing definitions and concepts around the globe
Diagnosis and management: 3 consecutive BP readings at regular intervals.
Signs and symptoms - fact or fiction?
Methodology – ‘Korotkoff’ sounds and their accurate usage. Why is palpation so important when assessing BP? Tradition versus common sense.
Clinical considerations – e.g. changes during pregnancy, exercise and ageing.
 

© Crawford & Cook 2005