Edema is commonly associated with venous insufficiency, a blood return problem. This disorder tends to get worse when the legs are allowed to dangle for prolonged periods below the level of the heart e. The fluid builds up preferentially in the most distal aspects of the leg and progress up towards the knee as the process worsens. Arterial insufficiency, on the other hand, rarely causes edema, which makes perfect sense as the problem lies in the delivery of blood to the extremity, not the return from it.
On occasion, the conditions may coexist. It may be difficult to detect small amounts of fluid. Look around the malleoli, as fluid will cause a loss of the normally distinct appearing edges of the bone. Similarly, fluid will tend to "fill in" the spaces between the extensor tendons on the top of the foot, causing them to appear less defined. If you're not sure whether fluid is present, push on the area for several seconds, release, and then gently rub your finger over that same spot, feeling for the presence of a "divot," referred to as pitting.
Much is said about pitting edema being associated with some disease states and non-pitting with others; however, the actual importance of this distinction is probably over stated. Also note the proximal extent of the edema and if it is present to the same degree in both legs.
Edema may either be diffuse, involving all of the surrounding tissue symmetrically, as is frequently the case in disorders of low oncotic or elevated hydrostatic pressure. If, however, there is a local inflammatory process, as might occur with cellulitis, the area of edema can be quite focal. A comparison of the different ways of quantifying edema are demonstrated here:.
Pulses are assessed to identify the presence of arterial vascular disease. In general, the less prominent the pulses, the greater the chance that there is occlusive arterial disease. This is not a perfect correlation, however, as pulses may be palpable even when significant disease is present e.
The location of the blockage s will dictate the symptoms and findings. Location of Dorsalis Pedis Artery. The pictures below demonstrate the location of the dorsalis pedis artery in relation to surrounding structures surface anatomy on left, gross anatomy on right. Location of Posterior Tibial Artery. Greg was a recipient of the EMS 10 Award for innovation.
He is also a three-time Jesse H. Connect with Greg on Twitter or LinkedIn and submit an article idea or ask questions with this form. You must enable JavaScript in your browser to view and post comments. More Product news. More Product Originals. All Distributors. Make EMS1 your homepage. More than EMS courses and videos totaling over continuing edcuation hours! Email Print Comment. Use these tips to find a patient's pedal pulses: 1.
Radial pulse first. Try the other leg If you are unable to find the pedal pulse on one leg, switch to the patient's other leg. Mark the location Once you have found a pedal pulse, consider using a ballpoint or felt pen to make a light mark at the pulse location to make reassessment easier. Foot temperature and color Finally, if the patient's foot is warm with normal color, it is adequately perfused.
This article, originally published December 7, , has been updated. Thank You! Join the discussion. Latest Product News 13 air, ground transport service agencies reaccredited; 1 gets initial accreditation. The current challenges of EMS education. Product Originals Testing, recertification and pandemic pivots 1. What do you do after the lift assist? What does the future hold for EMS education? Testing, recertification and pandemic pivots 1. You've been successfully signed up for the EMS1 Daily.
How to buy patient simulation devices eBook.
0コメント