4.4 DEEP VEIN THROMBOSIS Flashcards
Anatomy
(1) Lower extremity Deep veins:
(a) Posterior Tibial veins
(b) Anterior Tibial veins
(c) Popliteal veins
(d) Femoral veins
Pathophysiology
(1) DVT is a common condition caused by the formation of venous clots
(2) Related to presence of at least one of Virchow’s triad:
(a) Venous stasis
(b) Hypercoagulable state
(c) Injury to vessel wall
(3) NOTE: Most common life threatening consequence is a Pulmonary
Embolism (PE)
(4) Risk Factors (THROMBOSIS):
(a) Trauma, Travel
(b) Hypercoagulable, Hormones
(c) Recreational IV drugs
(d) Age > 60
(e) Malignancy
(f) Birth control
(g) Obesity, Obstetrics
(h) Surgery, Smoking
(i) Immobilization
(j) Sickness
Symptoms/Physical Findings
(1) Pain, redness, swelling, warmth, and tenderness
(2) Measure leg circumference and compare to unaffected leg
(3) If unilateral leg swelling then you MUST rule out DVT, or transfer to
somewhere that can
(4) Homan’s sign (pain with dorsiflexion) is unreliable sign for DVT
Differential Diagnosis
(1) Peripheral edema
(2) Varicose veins
(3) Cellulitis
(4) Thrombophlebitis
(5) Peripheral arterial disease affecting opposite leg
Labs/Studies
(1) D-dimer: D-dimer is one of the protein fragments produced when a
blood clot gets dissolved in the body. It is normally undetectable or
detectable at a very low level unless the body is forming and breaking
down blood clots
(2) Ultrasound: All patients with signs or symptoms of DVT need to
undergo an Ultrasound
Treatment
(1) Prevention of PE is primary goal of treatment
(2) Aggressive anticoagulation with Lovenox 1mg/kg SC q 12 hours OR
(3) Heparin: 80 units/kg IV loading dose, then initiate continuous infusion
18 units/kg/hr
(4) Pain control with Tylenol, Morphine
(5) Patient’s will need long term anticoagulation 3-6 months minimum
Initial Care
(1) ABCs, IV, O2, Monitor
(2) IF you suspect this then anticoagulate right away and MEDEVAC
Complications
(1) PE
(2) Death
