6- Yellow

Question 1

What physiologic measurements change with DVT/PE

Answer 1

Increased CVP
Increased PAP
Increased JVP
Decreased pCO2
PCWP DOES NOT INCREASE WITH PE

Question 2

What are the risk factors for DVT

Answer 2

Stasis

• immobility
• Prolonged/type of surgical procedures
• Paralysis
• Obesity
• CHF
• Pregnancy

Hypercoagulable state

• trauma
• Pregnancy
• OCP
• Malignancy
• Inherited coagulation deficiencies
• HIT
• Age >40

Endothelial damage
- previous DVT/PE

Question 3

What are the symptoms of a pelvic DVT

Answer 3

Thigh swelling / whole leg swelling

Question 4

What are the symptoms of a femoral DVT

Answer 4

Calf swelling

Question 5

What are the symptoms of a popliteal DVT

Answer 5

Asymptomatic

Question 6

Where do the majority of PEs originate?

Answer 6

Ileofemoral vessels (90%)

Question 7

What is the management of superficial thrombophlebitis

Answer 7

Excision & abx

Question 8

What is the management for deep vein thrombophlebitis

Answer 8

Abx and heparin

Surgery = last resort

Question 9

What is the clinical presentation of PE

Answer 9

Dyspnea
Chest pain
Tachycardia

Question 10

What investigations are helpful in diagnosis of PE

Answer 10

ABG
CXR
EKG
Leg Doppler 
Spiral CT 
TEE

Question 11

What are some EKG findings associated with PE

Answer 11

Tachycardia
A fib 
Ectopic beats 
Enlargement of P wave 
ST segment depression 
T-wave inversion 
S1Q3T3

Question 12

What is the management of PE

Answer 12

Heparin x 5-7 days while warfarin is started

• INR target 3 for prosthetics valves
• INR target 2.5 for DVT

Thrombosis is if hemodynamically unstable
Trans venous or surgical embolectomy if unstable
IVC filter if anticoagulation is contraindicated or a major bleed happens while on anticoagulation

Question 13

What are absolute indications for an IVC filter

Answer 13

Recurrent embolism despite anticoagulation
DVT or embolism in pt w/ Cis to anticoagulation
Complication of anticoagulation that forces therapy to be stopped
Recurrent PE with associated pulmonary HTN and cor pulmonale
Immediately after pulmonary embolectomy for massive PE

Question 14

What are relative indications for an IVC filter

Answer 14

PE > 1/2 pulmonary vascular bed in pts who cannot tolerate additional emboli
Propagating ileofemoral thrombus despite anticoagulation
High-risk patient with large free-floating ileofemoral thrombus on venogram