Table of Contents
- Wash hands
- Introduce self
- Ask Patient’s name, DOB and what they like to be called
- Explain examination and obtain consent
- Expose the patient’s legs. Check for any pain in legs.
- Look at the patient from the end of the bed
- Are they well/unwell?
- Any breathlessness?
- Are they in pain/discomfort?
- Consider DVT risks
- Signs of malignancy (e.g. cachexia)
- Signs of immobility (e.g. walking aids)
- Signs of recent surgery or trauma, pregnancy
- Look around the bed: medicines etc.
Inspect with the patient standing:
- Look at the patient’s skin: are there any colour changes?
- Ankle/leg swelling (unilateral may indicate DVT; bilateral may indicate oedema, e.g. in heart failure)
- Venous insufficiency signs
- Venous eczema and haemosiderin deposits (red-brown patches)
- Lipodermatosclerosis (‘inverted champagne bottle leg’; increased venous pressure causes inflammatory cells to fibrose subcutaneous tissue)
- Venous ulcers
- Note any venous dilatation and tortuosity (varicose veins)
Palpate with the patient supine:
- Temperature: feel for temperature differences between legs using the back of your hand (minimum three places each side)
- Tenderness: palpate for calf tenderness with knee slightly flexed (squeeze near ankle and then up calves while watching face)
- Pitting oedema: if present, establish how far oedema extends (and also check JVP)
- Calf diameters: measure circumference 10 cm below tibial tuberosity (>3cm difference = significant)
- Palpate pulses
- Thank patient and restore clothing
- ‘To complete my examination, I would perform full cardiovascular and respiratory examinations. I would review the patient’s observations, including oxygen saturations and respiratory rate. If these are abnormal, I would consider the possibility of a pulmonary embolism.’
- Summarise and suggest further investigations you would consider after a full history
Why don’t you test your knowledge?
How would you investigate a patient with a suspected DVT? Consider the Wells score in your answer.
Name five risk factors for venous thromboembolism
What is Virchow’s Triad?