Page 155 - Libro 2

8 — Indirect Assessment of Arterial Disease
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In lap
Military
Above head
Abducted
Hold up/head to L.
Hold up/head to R.
Digit
Figure 8-13 PPG waveforms recorded during various postural maneuvers.
with some tissue loss as well. The patients tend to be older, and it affects both men and women. The etiol- ogy of secondary Raynaud’s is trauma from the use of vibratory tools or equipment (jackhammers, rid- ing motorcycles, etc.), injury such as using the hand as a hammer (ulnar hammer syndrome), or severe frostbite. Other causes may include underlying medi- cal problems such as scleroderma.
When secondary Raynaud’s is suspected, the pa- tient should not have their hands immersed in ice water in order to avoid increasing the injury. Con- firmation of this, in addition to a careful history, is to record digital waveforms and digital pressures (as in recording toe pressures, PPG being the easiest method). The presence of tardus parvus waveforms (see Fig. 8-9 B) and/or abnormal pressures (DBI lower than 0.90) should alert the technologist of this possibility prior to water immersion.
The onset of primary Raynaud’s is typically seen in the late preteen or early teen years, with females tending to be more affected than males. In
ABC
DEF
Figure 8-14 Sketch showing patient positions used during thoracic outlet testing. A: Neutral, resting; (B) arms up with el- bows bent at 45°; (C) arms raised overhead; (D) arms abducted straight out, 90°; (E) Adson with head to the left; and (F) Adson with head to the right.