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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
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