Deteriorating Patient
Deteriorating Patient
 

Lower Limbs

 
 
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Assessing the Calves

  • Look at and feel the patient’s calves, looking for signs of deep venous thrombosis.
    • Signs of DVT

    • Erythema
    • Swelling
    • Tenderness

Peripheral Oedema

  • Look for swelling of the lower limbs; apply pressure to the anterior aspect of the tibia for fifteen seconds and then release to assess for pitting oedema.
    • Causes of Oedema

    • Pitting

    • Fluid overload - excessive IV fluids, renal failure, heart failure
    • Right ventricular failure
    • Venous pathology - thrombosis / insufficiency
    • Dependency (the effect of gravity)
    • Hypoalbuminaemia - malnutrition, malabsorption, nephrotic syndrome, liver (synthetic) failure
    • Non-Pitting

    • Impaired lymphatic drainage
    • Pretibial myxoedema (hypothyroidism)

Lower Limb Pulses

  • Strong femoral, popliteal, posterior tibial and dorsalis pulses are reassuring, while weak or absent lower limb pulses represent vascular compromise that may be limb-threatening if acute.
    • Pulses in the Lower Limb

    • Femoral - palpate within the inguinal region, halfway between the pubic symphysis and iliac crest.
    • Popliteal - bend the patient's knee to 90 degrees, gently grasp both sides of the knee joint and palpate using tips of fingers within the popliteal fossa posteriorly.
    • Posterior tibial - palpate posteriorly and inferiorly to the medial malleolus.
    • Dorsalis pedis - palpate lateral to the extensor tendon of the great toe. This can be identified by asking the patient to extend their great toe.
    • Causes of Absent Lower Limb Pulses

    • Vascular trauma
    • Compartment syndrome
    • Peripheral vascular disease
    • Abdominal aortic aneurysm
    • Shock
Last updated on April 15th, 2020
 
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