case 5

Question 1

Well Criteria for DVT

Answer 1

Cancer tx within the last six months or currently
Paralysis or paresis or cast of lower extremity
Bedridden for at least 3 days in last for weeks or major surgery in the last 12 weeks
Tenderness located along deep venous system
entire leg swelling
unilateral calf swelling >3cm compared to other calf
unilateral pitting edema
superficial collateral veins
prior DVT
Alternate dx is less likely

Question 2

Scoring for Wells what do you do for each score

0 points
1-2 points
3-8 points

Answer 2

0 points: order a d-dimer
1-2: order highsensitivity D-dimer
3-8 points: ultra sound no d-dimer

Question 3

Well Criteria For PE

Answer 3

DVT symptoms
PE is likely or more likely than any other dx
Bed rest >3 days or surgery in the last 4 weeks
Previous DVT/ PE
Hemoptysis
Cancer tx in the last six months or current tx
Heart rate >100

Question 4

Score what to do in each situation
Low <2
Intermediate 2-6
High >6

Answer 4

<2 : apply perc score
2-6 D-dimer
>6 CTPA

Question 5

PERC (PE rule out criteria)

Answer 5

Age <50
HR <100
O2 sat >95 %
No hemoptysis 
No estrogen use 
No prior DVT or PE
No unilateral leg swelling 
No sx or trauma requiring hospitalization in the last four weeks

Question 6

things that can cause elevated d-dimer

Answer 6

MI, CVA, DIC, CHF, pregnancy, renal dz, liver dz

There is alot more, make sure to review

Question 7

You have a patient with high probabilty for a DVT. You get an US. On the ultrasound you would expect to see___________ of the veins in a positive case

Answer 7

Non compressibility

Question 8

Where would you see distal DVT?

Answer 8

Anterior tibial veins
posterior tibial veins
peroneal veins

Question 9

Where would you see proximal DVT?

Answer 9

Popliteal veins
Femoral veins
Iliac veins

Question 10

You have a patient with a PE and their BP is 89/60. Is this patient hemodynamically stable? And what are you next steps?

Answer 10

No this pt is not hemodynamically stable. Systolic BP is below 90.
You would need to give IV fluids and vasopressors. You would also need to give this person systemic thrombolytics and embolectomy. This pt has a very large PE

Question 11

In starting coumadin you need to _______ with _______to cover the patient until the coumadin is at ideal levels and take effect.

Answer 11

Bridge with heparin

Question 12

Patients with DVT or PE need to be on anticoags for a minimum of ______ months, and then re evaluated

a. 2
b. 3
c. 4
d. 6

Answer 12

b. 3 months

Question 13

NOACS are a nice choice because you do not need to take the additional step of ______.

Answer 13

bridging

Question 14

Some Meds that can cause a prevoked DVT

Answer 14

Steroids, estrogen, OCPs, testosterone, tamoxifen