13How is it Measured? Blood Pressure (Systolic only taken on both arms Blood Pressure (Systolic only taken on both anklesDoppler is used (8 mgHz)Arm – Brachial pulse is usedLegs – Dorsalis Pedis is used
14How Do You Get the Number? Formula (ABI)Ankle PressureBrachial Pressure
15But what do the numbers Mean? Result of <0.5 = IschemiaResult of 0.5 – 0.8 = Moderate IschemiaResult of 0.8 – 1.0 = Mild Ischemia/NormalAnything over 1.0 is either normal or may indicate calcified arteries in Diabetics.In this case toe pressures are indicated
16Why Might Toe Pressure Numbers Differ? Microcirculation vs Macrocirculation!
17Results55 mmHg = >0.6 toe brachial index (Low Risk)40 mmHg = >0.4 toe brachial index (Mod. Risk)20 mmHg = >0.2 toe brachial index (High Risk)<20 mmHg = < 0.2 toe brachial index (Severe Risk)If trying to heal an ulcer on the heel, then poor vascularization in the toes is not as critical
18BUT….How do we differentiate between ulcers that will heal and those that need palliative care?
19CharacteristicArterialVenousLocationUsually distal(Top of foot)Above malleolusSizeSmall/punched outCan be quite largeShape/MarginsRound/SmoothIrregularDepthCan become quite deepUsually shallowWound Bed BasePale pink – greyVariable – usually beefy redSurrounding SkinPalePigmented
26Remember! IF SURGERY IS UNDERTAKEN – THERE IS A FRESH BLOOD SUPPLY FOR ANY RESIDENT BACTERIA! = INFECTION!!
27Conservative Treatment Cadexomer Iodine and Povidine
28Low Dose ASA to prevent clots Other Measures?Viagara??Low Dose ASA to prevent clotsStatin Medication to lower plaque buildup
29GANGRENE decay of body tissues caused by infection/ischemia/thrombus can be black, brown or greenMalodorous!!Generally associated with Diabetics and SmokingFrostbite
30BEGINS AT DISTAL PART OF LIMB DUE TO ISCHEMIA DRY GANGRENEBEGINS AT DISTAL PART OF LIMB DUE TO ISCHEMIAOFTEN IN THE TOES OF ELDERLY PEOPLESPREADS SLOWLYAPPEARS BLACK, SHRUNKEN (MUMMIFIED)PT. HAS DULL ACHE AND SENSATIONS OF COLDNESSIF CAUGHT EARLY AND REVASCULARIZED – SOMETIMES THE LIMB/DIGIT CAN BE SALVAGED
32WET GANGRENE Generally occurs in moist tissue and organs Tissue is infected by bacteria which have a putrid smell to themDevelops quickly due to arterial and/or venous blockageToxic products of bacteria responsible for sepsis – death.
38InfectionKeep gangrenous/arterial area as dry as possiblePatients very prone to developing osteomyelitis as ulcers can be quite deepPovidine – Don’t dress until dryTightly woven dressings better (no loose fibres)