ABSI (ABI) Screening — Pulse, Colour & CRT + Share & Send

1) Maklumat Klien

Tarikh & Masa

Nama Penuh *

No. IC / MyKad *

No. Telefon *

Tarikh & Masa

Alamat

2) Faktor Risiko

Pilih yang berkenaan

3) Gejala (Symptoms)

Tanda amaran PAD

Tiada gejala Sakit betis ketika berjalan (claudication) Sakit kaki ketika rehat (rest pain) Ulser/luka kaki lambat sembuh Kaki sejuk/pucat Kebas / lemah Nadi kaki lemah/tiada Perubahan kulit/kuku (nipis/tebal)

4) Peripheral Pulse Examination

DP & PT — Right / Left

Record pedal pulses for Dorsalis Pedis (DP) and Posterior Tibial (PT) on both sides. Select one option for each pulse.

5) Skin Colour & Capillary Refill

Right / Left

Select foot skin colour and enter capillary refill time (CRT, seconds). Normal CRT ≤ 2s; delayed ≥ 3s.

Right foot colour

Pink Pale Cyanotic Mottled

Right CRT (seconds)

Left foot colour

Pink Pale Cyanotic Mottled

Left CRT (seconds)

6) Pengukuran Tekanan & Kiraan ABI

Auto-kira

Masukkan tekanan sistolik (mmHg). Algoritma akan gunakan nilai brachial (lengan) tertinggi sebagai penyebut.

Brachial (Kanan)

Brachial (Kiri)

Ankle Kanan (DP/PT tertinggi)

Ankle Kiri (DP/PT tertinggi)

ABI Kanan: –

Klasifikasi

ABI Kiri: –

Klasifikasi

7) Rumusan (English Text)

Auto-generate

Reference—Normal: 1.00–1.30, Borderline: 0.91–0.99, PAD: ≤0.90 (mild–moderate 0.41–0.90, severe ≤0.40). Non-compressible: >1.30. Normal CRT ≤ 2s.

8) Share & Send

Template Summary

1) Maklumat Klien

2) Faktor Risiko

3) Gejala (Symptoms)

4) Peripheral Pulse Examination

5) Skin Colour & Capillary Refill

6) Pengukuran Tekanan & Kiraan ABI

ABI Kanan: –

ABI Kiri: –

7) Rumusan (English Text)

8) Share & Send

ABSI (ABI) Screening Summary