Chapter 36 Flashcards
What are the differential diagnosis for unilateral painful swollen leg?
Lymphedema, DVT, cellulitis, Baker cyst, trauma
What part of physical findings are present in DVT?
Positive Homans sign, warmth and Edema in right lower extremity
What are the two most commonly used noninvasive confirmatory test screening test? What is the gold standard?
Doppler ultrasound and IPG (impedance plethysmography); Venography
What should be done if suspicion of DVT is high and initial noninvasive test is negative?
Repeat US/IPG on date 5 and 7
What all plays a role in the diagnosis of DVT?
Pretest probability, D-dimer results, non-invasive testing
Why is BMP tested in patients with DVT?
Because IV unfractionated heparin is preferred over LMWH in the management of patients with advanced renal failure
What are the test we should order for DVT?
CBC, BMP, FOBT, PTT, PT/INR, D dimer, lower extremities Doppler ultrasound
How should follow up for DVT patients go?
Follow-up visit should be daily to monitor INR and clinical improvement
How should DVT patients given heparin be monitored?
Platelet count should be monitored on day three and day five while on heparin
What DVT patients should be hospitalized?
Massive DVT, suspicion of pulmonary embolism, risk of bleeding while on anti-coag and underlying condition requiring inpatient care
What are the choices for anticoagulant therapy in simple DVT’s?
LMWH plus warfarin or fondaparinux plus warfarin
What is the most common LMWH used?
Enoxaparin (Lovenox)
What should be done to screen for Heparin induced thrombocytopenia?
Obtain platelet count on day three and a five
When is warfarin added to Heparin?
Within 24 hours of heparin initiation
When is heparin discontinued?
After five days if INR is therapeutic (2-3) For 24-48 hours
