Chapter 6 Flashcards
How many cases of Pulmonary Embolus occurs annually?
600,000
How many deaths are a result of PE?
200.000
How many new cases of DVT (Deep Vein Thrombosis) occurs annually?
1-10million
What is a blood clot?
Applies to a clot anywhere, even in a test tube
What is a thrombosis?
The formation of a blood clot in an artery or vein
What is a thrombus?
The actual clot within a vessel
What is a thromboembolism?
A thrombus that breaks free and travels
What occurs with Phlebitis?
Inflammation of a vein wall
What is thrombophlebitis?
Thrombus associated with phlebitis
What is a thrombus that travels to the heart, through the heart and to the lungs?
Pulmonary Embolism (PE)
What is a thrombosis in a superficial vein?
Superficial Thrombophlebitis
Who postulated that there were three related factors that caused venous thrombosis?
Dr. Virchow
What are the three parts of Virchow’s triangle?
Stasis, Hypercoaguability, Vein Wall Injury
What are risk factors for DVT?
Post Operative State Previous DVT Cancer Thrombophilia Trauma Pregnancy High Dose Estrogen Rx "Economy Class Syndrome"
What are the symptoms of DVT?
Persistent leg pain with acute onset
Persistent leg swelling
Calf pain/tenderness
( If pts have above symptoms 50% of DVT)
In the clinical diagnosis of DVT, what is associated with low sensitivity and low specificity?
Low Sensitivity- Many Patients are asymptomatic
Low Specificity- Non-thrombotic disorders can cause the same clinical symptoms as DVT.
What signs and symptoms are associated with Phlegmasia Cerulea Dolens?
Massive thigh and calf swelling
Limb Cyanosis
Ilio-Femoral outflow obstruction
What are the symptoms associated with Superficial Thrombophlebitis?
Erythemia/inflammation
local tenderness
palpable cord or mass
usually more painful than DVT
Is Superficial Thrombophlebitis life threatening?
Usually not life threatening, unless the thrombus extends/propagates into the deep system
What is looked for in a venous physical exam?
Swelling Limb discoloration Stasis dermatitis, ulceration Varicose Veins Palpable "cords" (STP)
What are the venous duplex techniques?
- ) compressibility/coaptation of the vein
- ) Visualization of Thrombus
- ) Spectral Doppler
- ) Color Doppler
What position is the lower venous exam began in?
With pt in a Semi-Fowler’s or Reverse Trandelenburg postion
About how many degrees is the head of the bed elevated in a Reverse Trandelenburg position?
25-45 degrees
How many degrees is the torso elevated?
10-20 degrees
How is the patient’s leg rotated?
Leg rotated externally
What vein is located just proximal to inguinal ligament at the groin crease?
Distal external iliac vein
Where does the sapheno-femoral junction occur?
At the location of the CFA bifurcation
In lower venous scanning when is the image best in accordance to probe position?
The best image is when the ultrasound beam is perpendicular to the vessel.
If a thrombus is found in the GSV what should one determine?
If the thrombus extends into the CFV at the sapheno-femoral junction
How often should compressions be done to determine coaptation?
Compress every 2-4 cm along the length of the common femoral, femoral, popliteal, and calf veins
At the level of the adductor canal, the femoral vein may be difficult to compress due to what factors?
Due to the depth of the vessel and proximity to the adjacent femur
What may prevent coaptation of the popliteal vein?
If the transducer is placed directly over the biceps femoris tendon laterally or the semitendinosus tendon medially in the popliteal fossa
If the distal popliteal vein is not clearly visualized what can be used to assist in visualization?
Imaged with color doppler in longitudinal plane
What is spontaneity?
Flow that is present without augmentation maneuvers
What is respiratory phasicity?
Flow should increase and decrease with respiration
Augmented flow can easily occur in the presence of DVT via what?
The collateral channels
What is augmentation particularly useful for?
Calf vein flow evaluation and for reflux assessment
Spectral and Color Doppler Techniques
(Longitudinal Evaluation)
Look For
Spontaneous flow?
phasic with respiration?
augments with distal limb compression?
reflux?
Typically is the flow direction above or below the baseline?
Below baseline
Is continuous venous flow in the CFV a normal finding?
No-Abnormal Finding
Is venous reflux a normal finding?
Abnormal Finding
