Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Introduction
- Acknowledgments
- List of abbreviations
- Section 1 Principles of surgery
- Section 2 General surgery
- Section 3 Breast surgery
- Section 4 Pelvis and perineum
- Section 5 Orthopaedic surgery
- Section 6 Vascular surgery
- 24 Examination of the carotid artery
- 25 Examination of an abdominal aortic aneurysm
- 26 Arterial examination of the upper limbs
- 27 Arterial examination of the lower limbs
- 28 Examination of the lower limb venous system
- 29 Examination of ulcers
- Section 7 Heart and thorax
- Section 8 Head and neck surgery
- Section 9 Neurosurgery
- Section 10 Plastic surgery
- Section 11 Surgical radiology
- Section 12 Airway, trauma and critical care
- Index
24 - Examination of the carotid artery
from Section 6 - Vascular surgery
Published online by Cambridge University Press: 05 July 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Introduction
- Acknowledgments
- List of abbreviations
- Section 1 Principles of surgery
- Section 2 General surgery
- Section 3 Breast surgery
- Section 4 Pelvis and perineum
- Section 5 Orthopaedic surgery
- Section 6 Vascular surgery
- 24 Examination of the carotid artery
- 25 Examination of an abdominal aortic aneurysm
- 26 Arterial examination of the upper limbs
- 27 Arterial examination of the lower limbs
- 28 Examination of the lower limb venous system
- 29 Examination of ulcers
- Section 7 Heart and thorax
- Section 8 Head and neck surgery
- Section 9 Neurosurgery
- Section 10 Plastic surgery
- Section 11 Surgical radiology
- Section 12 Airway, trauma and critical care
- Index
Summary
Checklist
WIPER
• Patient sitting in chair with neck, shoulders and upper chest exposed.
Physiological parameters
Inspection
• Scars from previous carotid endarterectomy
• Thoracic scars: midline sternotomy scar for CABG
• Scars from other head and neck surgery (hostile neck)
• Radiotherapy marks (hostile neck)
• Masses in anterior triangle or deep to SCM (carotid body tumours or aneurysms)
• Neurology: arm or leg weakness; facial asymmetry; speech disturbance
Palpation
• Radial pulse for AF
• Pulsatile neck masses (carotid body tumours or aneurysm)
• Carotid pulse
• Carotid thrill (arteriovenous fistula)
Move
• Neck mobility (to assess suitability for CEA)
Auscultation
• Carotid artery bruit
• Heart sounds
To complete the examination…
• Perform a full neurological and cardiovascular exam.
• Examine upper limb pulses to exclude steal syndrome.
• Check ECG: AF and ischaemic changes.
• Perform a fundoscopy of the retinal arteries to exclude embolism.
Examination notes
What aspects of carotid artery disease must be established?
• Establish presence of any neurological deficits: asymptomatic, transient ischaemic attacks, cerebrovascular accident.
• Establish the nature of neurological deficit: amaurosis fugax, speech impairment, facial asymmetry, focal neurological defect.
• Establish time since neurological event, recovery from stroke and residual functional deficit.
Where should the carotid bifurcation be palpated?
The carotid bifurcation is found at the level of the thyroid cartilage. Palpate this medially then slide fingers laterally to the anterior aspect of the sterno-cleidomastoid muscle. The presence of a carotid pulse does not exclude a stenosis of the internal carotid artery distal or proximal to it.
Where should one auscultate for carotid bruits?
Carotid bruits are best heard at the angle of the mandible. The absence of a bruit does not exclude carotid artery disease.
What are the different carotid endarterectomy scars?
• Longitudinal incision parallel and anterior to the anterior edge of the sternocleidomastoid muscle.
• Transverse incision across sternocleidomastoid at the level of the upper thyroid cartilage.
- Type
- Chapter
- Information
- Physical Examination for SurgeonsAn Aid to the MRCS OSCE, pp. 203 - 207Publisher: Cambridge University PressPrint publication year: 2015