DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM Flashcards
WHAT IS A THROMBUS MADE OF
RED BLOOD CELLS
PLATELETS
FIBRIN
FACTORS THAT PROROMOTE THROMBOSIS
VIRCHOWS TRIAD
COMPOMNETS OF VIRCHOWS TRIAD
STASIS
CHANGE IN THE COMPONENTS OF BLOOD /ABNORMAL BLOOD / HYPERCOAGULABILITY
CHANGE IN THE INTIMAL SURFACE OF THE BLOOD VESSEL
DIFERENCE BETWEEN ARTERIAL AND VENOUS THROMBOSIS
REFER TO TABLE
FACTORS THAT MAY BE SUGGESTIVE OF STASIS
LONG HAUL FLIGHTS
IMMOBILITY
FACTORS THAT MAY BE SUGGESTIVE OF CHANGE IN THE INTIMAL SURFACE OF THE ARTERY
TRAUMA
SURGERY
VENOUS CATHETERS
FACTORS THAT CAUSE ENDOPTHELIAL DYSFUNCTION
SMOKING
DIABETES
HIGH CHOLESTEROL
HYPERTENSION
FACTORS THAT CAUSE HYPERCOAGULABILITY
PREGNANCY
CANCER
SEPSIS
ORAL CONTRACEPTIVE
SICKLE CELL DISEASE
WHAT IS EMBOLISATION
DISSEMINATION OF A PART OF A THROMBUS TO OTHER REGIONS OF THE BODY
PREVENTION OF VENOUS THROMBOEMBOLISM
EARLY EMBOLISATION AFTER SURGERY
STOCKINGS
ANTICOAGULANT BEFORE SURGERY
SIGNS OF DVT
UNILATERAL SWELLING
CALF TENDERNESS
REDNESS
PITTING OEDEMA
PROMINENT COLLATERAL VEINS
PERSISTING DISCOMFORT
PROBABILITY SCORE FOR DVT
WELLS SCORE
INVESTIGATIONS FOR DVT
D-DIMER
PERFORM A DOPPLER COMPRESSION ULTRASOUND IF POSITIVE D-DIMER
WELLS SCORE EXCLUSION
PREGNANCY
MEANING OF A POSITIVE DDIMER TEST
POSITIVE D DIMER IS NOT A CONFIRMATION OF DVT AS MANY FACTORS CAUSE A RAISED D DIMER
FURTHER ULTRASOUND SHPOULD BE CONDUCTED ON THIS
WHAT IS A DDIMER TEST
A TEST THAT MEASURES A PROTEIN RELEASED T DURING THROMBOLYSIS /DISSOLVE BLOOD CLOTS COULD BE SUGGESTIVE OF DVT OT PE
SYMPTOMS OF A PULMONARY EMBOLSIM
PLEURITIC PAIN ( STABBING PAIN THAT WORSENS ON BREATHING)
BREATHLESSNESS
HAEMOPTYSIS
INCREASED HEART RATE
PLEURAL INFARCTION
SYMPTOMS OF SUDDEN OR MASSIVE PULMONARY EMBOLISM
Severe dyspnoea of sudden onset
Collapse
Blue lips and tongue - cyanosis
Tachycardia
Low blood pressure
Raised jugular venous pressure
INVESTIGATIONS
BLOOD GAS - LACTATE IS HIGH
D DIMER ON BLOODS
DIAGNOSTIC TOOLS FOR PULMONARY EMBOLISM
CT PULMONARY ANGIOGRAM
PERFUSION SCAN IF D-DIMER IF LOW PRE TEST PROBABILITY SCORE
DOPPLER ULTRASOUND
QUESTIONS TO ASK FOR A VENOUS THROMBOEMBOLISM
Was there a clear cause or precipitant?
Recent surgery / hospitalisation
Any symptoms or signs to suggest underlying malignancy?
Consider risk of recurrence
Clinical Risk
Cancer patients
DASH score/ HERDoo2 etc
TREATMENT OPTIONS FOR PULMONARY EMBOLISMN
ANTICOAGULATION
CHECK FOR THE CAUSATIVE FACTOR AS WELL ESP IN UNPROVOKED
LONG TERM CONSEQUENCES OF DVT
Post Thrombotic Syndrome
Damage to venous valves
Incidence of 20-60% within 2 years of DVT
Swelling
Discomfort
Pigmentation
Ulceration in severe form
Role for compression hosiery
