PV

Circulatory System Overview

  • Roles of arteries and veins

    • Arteries carry oxygenated blood from the heart to the body, with the exception of pulmonary arteries.

    • Arteries typically appear red due to high oxygen content.

    • Veins carry deoxygenated blood from the body back to the heart, with pulmonary veins as the exception.

    • Veins often appear darker but not blue; they can appear darker due to lower oxygen levels but have a more reddish tint than blue.

Structure of Blood Vessels

  • Arteries features

    • Thicker walls equipped with a muscular layer to handle high-pressure blood flow.

  • Veins features

    • Thinner walls that require valves to prevent backflow of blood (gravity assistance).

    • Lack of muscle thickness, hence, more dependence on one-way valves.

Peripheral Vascular Disorders

  • Peripheral vascular venous disorder (PVVD)

    • Conditions can lead to blood pooling, especially in lower extremities.

    • Symptoms include discomfort and leg pain due to insufficient blood return to the heart.

Microcirculation

  • Capillaries

    • 80% of circulation occurs here; they facilitate gas exchange at a micro-level.

    • Intravenous (IV) access typically occurs through veins.

Major Blood Vessels

  • Great Vessels

    • Aorta: Carries oxygenated blood to the body.

    • Superior & Inferior Vena Cava: Bring deoxygenated blood to the heart.

Blood Flow

  • Circulation process

    • Blood flows through the heart, lungs, and body in a loop.

    • Oxygenated and deoxygenated blood flows in separate circuits that do not intertwine.

Intermittent Claudication

  • Definition

    • Occurs when reduced blood flow leads to muscle pain during activities like walking or climbing stairs.

    • Example: Pain may start reproducibly with physical activity and disappears with rest.

Assessment of Peripheral Circulation

Symptoms and Signs

  • Symptoms to assess in patient history

    • Leg Pain: Assess for intermittent claudication.

    • Discoloration: Evaluate the skin for pallor or abnormal coloration indicating poor circulation.

    • Varicose veins: Look for visible veins or varicosities, particularly in the legs.

    • Skin breakdown: Identify localized ulcerations due to prolonged blood stagnation.

    • Edema: Recognize swelling often linked to fluid accumulation (third spacing or angioedema).

Raynaud's Disease

  • Overview

    • Genetic predisposition, causing excessive vasoconstriction in response to cold.

    • Characteristic symptoms: Fingertips or other extremities turning white, sometimes painful as blood flow is restored.

Arterial Problems Assessment

The Three Ps

  • Indicators of arterial problems

    • Pain: Suggests insufficient oxygen to tissues.

    • Pallor: Indicates lack of blood flow; should appear pink in healthy tissues.

    • Pulselessness: Absence of pulse in the extremities suggests a serious issue.

Venous Stasis and DVT

  • Venous stasis

    • Occurs when blood pools due to ineffective vein valves. Can lead to deep vein thrombosis (DVT).

  • Symptoms of DVT

    • Pain, swelling, warmth, and erythema in affected area.

    • Observations of swelling compared between limbs: Swollen with DVT vs. non-swollen.

Stroke Signs

  • Recognition

    • Use 'FAST' to identify stroke symptoms:

    • Face drooping,

    • Arm weakness,

    • Speech difficulty,

    • Time to call emergency services (consider window for treatment).

Preventative Measures

  • Sequential Compression Devices (SCDs)

    • Used in patients who are sedentary post-surgery to promote circulation.

  • Other interventions

    • Ambulation: Encourage movement to prevent stasis.

    • Avoid crossing legs: Can impede venous return.

    • Monitor IVs: Avoid site trauma that can contribute to clot formation.

Risk Factors

  • Conditions leading to increased risk of DVT

    • Prolonged immobility (e.g., post-surgery, long flights).

    • Medication (e.g., oral contraceptives).

    • History of heart disease.

Treatment Options

  • DVT Management

    • Medications: Anticoagulants such as Heparin or Lovenox.

    • Monitoring and adjustments based on the patient's condition.

Physical Exam Techniques

Inspection

  • Assess for peripheral perfusion:

    • Observe skin coloration, temperature, and texture.

    • Check for clubbing, edema, or varicosities.

Palpation

  • Assess arterial pulses:

    • Use of two fingers to palpate bilaterally.

    • Evaluate rate, rhythm, amplitude of pulses.

Capillary Refill Assessment

  • Technique

    • Pinch the nail bed; time how long it takes for color to return.

    • Normal < 2 seconds; delayed indicates potential perfusion issues.

Special Techniques

Allen Test

  • Assess ulnar perfusion by occluding both the radial and ulnar arteries, then releasing one and observing refill.

Bruits Assessment

  • Listen for turbulent blood flow over arteries using a stethoscope's bell.

    • Indications of stenosis or plaque buildup may have clinical significance.

Blood Pressure Measurement

  • Compare readings in both arms.

  • Significant discrepancies may indicate vascular issues.

    • Example: If one arm has markedly higher or lower readings, further investigation is warranted.

Additional Considerations

  • Understand potential arterial and venous disorders upon examination.

  • Assure continuity of care post-injury to prevent complications and ensure proper blood flow.