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Trick of the Trade: Ultrasound for Pedal Pulse Identification and ABI

ultrasound for pedal pulse PT The Problem: A patient is rolled in to your ED by EMS with extremity trauma. You’re rightfully concerned about possible vascular injury to an upper or lower extremity, but you can’t palpate a dorsalis pedis (DP) or posterior tibialis (PT) pulse! You spend minutes, whisking the doppler probe, attempting to hear a waveform in a busy ED. Unfortunately you can’t seem to hear the “whoosh,” making accurate it nearly impossible for you to measure ankle-brachial indices (ABI). 1–3

Trick of the Trade:

Find and mark your pedal pulses using ultrasound

Use the linear probe of your ultrasound. Mark the locations of the DP and PT arteries for easier localization with the doppler probe.

  1. Place the linear ultrasound probe over where you would expect the artery to pass.
  2. Mark the location of the artery with a pen.
  3. Use the doppler machine to listen to arterial flow.
  4. Measure the ABI (ABI technique).

Ultrsound Pedal Pulse 4 images

Now you will know whether your lack of flow is secondary to decreased flow versus just testing in the wrong place!

1.
Roberts JR. Roberts and Hedges’ Clinical Procedures in Emergency Medicine. 6th ed. Saunders; 2013.
2.
Peripheral Arterial Ultrasound Examinations Using Color and Spectral Doppler Imaging. American Institute of Ultrasound in Medicine. http://www.aium.org/resources/guidelines/peripheralarterial.pdf. Published 2014.
3.
Rolston D, Saul T, Wong T, Lewiss R. Bedside ultrasound diagnosis of acute embolic femoral artery occlusion. J Emerg Med. 2013;45(6):897-900. [PubMed]
Christian Rose, MD

Christian Rose, MD

Clinical Informatics Fellow
Stanford University;
Emergency Physician, Kaiser Permanente
Joe Sills, MD

Joe Sills, MD

Senior Resident
UCSF-SFGH Emergency Medicine Residency Program
William Shyy, MD

William Shyy, MD

Assistant Clinical Professor
Department of Emergency Medicine
University of California, San Francisco