Dictation Practice – Part A08
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- leg circulation
- arterial circulation
- femoral pulse
- behind knee
- physical signs
- dependent rubor
- capillary refill
- (about) two minutes
|Hi Mr.Friedman. How are you today?
|I’m good. Thank you.
|Okay Mr.Friedman. I’d like to take a look at your leg now, if you don’t mind.
|I’d like you to lie down if you would please.
|There you go.
Based on what you’ve told me so far, I suspect you have a problem with the circulation in your leg and that the arterial blood flow might not be as good as it could be.
And so I’d like to proceed to do an arterial circulation examination.
I suspect the patient suffers from peripheral vascular disease. And so I would like to do an arterial circulation examination beginning with the femoral pulse.
|Femoral pulses are normal bilaterally. No bruit is heard. Please move on.
|Mr.Friedman, I would now like to take a look at the pulse behind your knee.
I just need to bend your knee a little bit and you’re gonna feel me pushing behind it just like this as I look for the pulse. This one can be hard to find sometimes.
So with the knee in a slightly flexed position, I’m assessing for popliteal pulse intensity bilaterally, popliteal pulse are equal and normal bilaterally.
I’d now like to proceed to do more and evaluation of the peripheral circulation and I will compare both sides.
So with your leg nice and straight, I’m assessing for the posterior tibial pulse. On both sides. As well as the dorsalis pedis. I feel both pulses present equal and bilateral.
I’d now like to move on and do another examination, looking for some of the physical signs of vascular insufficiency and this would include looking for changes in the skin, hair on his feet, his nails, as well as looking at dependent rubor and pallor on elevation.
So Mr.Friedman, I’m just taking a look at your feet. I see that your skin looks normal. You have some hair which is normal. You have a good capillary refill, which means that the circulation and the very small vessels of your feet is good.
Now I’d like to proceed to special maneuvers and this would include looking at pallor on elevation as well as dependent rubor.
Mr.Friedman, I’m just going to lift your leg a little bit. Okay. You don’t have to do anything. Just relax.
So normally I would maintain the leg in the air like this for about two minutes and be looking at the foot for pallor. A little bit of pallor is normal but..
|Noted. You may move on.
|Okay. And now, if I could have you sit up Mr.Friedman and just have your feet hang over the side of the bed for me. There you go. All right.
Again, I would suspect that this would take a couple of minutes before I would see any redness.