I worry a little about technical trouble if flat waveform seen with
normal pressure, but I suppose the injured finger may have some sort of
ecchymosis/hematoma interfering with PPG and the pressure is probably
real- could also be vasomotor related to the trauma- what kind of trauma
to what part of finger? Doppler signal quality in proper digital
arteries at proximal finger? One might consider having him seen by
vascular surgeon and/or an angiogram
Joe


Joseph R. Schneider, MD, PhD
Vascular and Interventional Program of Central DuPage Hospital
Ambulatory Services Pavilion Suite 201
25 North Winfield Road
Winfield, IL 60190
Voice 630-933-4487
Professor of Surgery, Northwestern University Medical School
 

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-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Jeffrey
Yarus
Sent: Tuesday, September 25, 2007 9:36 AM
To: [log in to unmask]
Subject: Re: Upper Extremily Arterial Question


 

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Bonnie
Johnson
Sent: Friday, September 14, 2007 12:27 AM
To: [log in to unmask]
Subject: UE Arterial Question

We had a patient arrive for an Upper Extremity exam with a trauma to his
left index finger.
The Doctor's office had an indication of Digital Cysnosis.

Finger looked normal except pt complained of poor capillary refill. He
had no pain in the finger Or cold sensitivity.

Exam results: Waveforms in the Brachial, Radial and Ulnar were
triphasic and above 1.0

PPG waveform is the fingers in the left hand were normal in all finger
EXCEPT the finger with the trauma.
The finger in question had a flattened waveform but the pressure was
within the range of the other fingers, 0.94.

This finding did not make sense?

I performed a cold stress exam in the left hand because the doctor had
requested the test.

After 4 minutes of his fingers in ice water, the waveforms in all of the
fingers REMAINED the same after Cold stress. The finger with the trauma
showed a flattened waveform again with NO change?

The reading Doctor is puzzled as I am with these findings?

Any Ideas would be helpful!!

Thank you,
Jeffrey Yarus
Cheshire Medical Center
Vascular Lab
Keene, NH





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