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Burton Nathan Raffel (April 27, 1928 – September 29, 2015) was an American writer, translator, poet and professor. He is best known for his vigorous [ 1 ] translation of Beowulf , still widely used in universities, colleges and high schools.
On inspection the clinician looks for signs of: trauma; previous surgery ()muscle wasting/muscle asymmetry; edema (swelling) erythema (redness); ulcers – arterial ulcers tend to be on the borders / sides of the foot, neuropathic ulcers on the plantar surface of the foot, venous ulcers tend on be on the medial aspect of the leg superior to the medial malleolus.
The pulses should be palpated, first the radial pulse commenting on rate and rhythm then the brachial pulse commenting on character and finally the carotid pulse again for character. The pulses may be: Bounding as in large pulse pressure found in aortic regurgitation or CO 2 retention.
For both legs compare true (ASIS to medial malleolus) and apparent (umbilicus to medial malleolus) leg length. Ask the patient to: "put your heel onto your bottom" to test knee flexion. Place your hand over the knee and then the hip joints feeling for crepitus as the patient moves these joints.
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease .
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Parasternal heave occurs during right ventricular hypertrophy (i.e. enlargement) or very rarely severe left atrial enlargement. [4] This is due to the position of the heart within the chest: the right ventricle is most anterior (closest to the chest wall).
If the pulse oximeter is attached without compressing the skin, a pressure pulse can also be seen from the venous plexus, as a small secondary peak. The change in volume caused by the pressure pulse is detected by illuminating the skin with the light from a light-emitting diode (LED) and then measuring the amount of light either transmitted or ...