diagnosis, prevention and treatment of DVT Flashcards
what are the symptoms of DVT?
pain swelling tenderness warmth redness/discolouration
what are the investigations done for DVT?
D dimer
ultrasound compression test
How is DVT treated?
- LMW heparin subcut once daily for a minimum of 5 days
- start warfarin at the same time as heparin and continue heparin until the INR is 2-3, then stop heparin and carry on with warfarin for 3 months
- compression stockings
- treat underlying cause eg malignancy or thrombophilia
what are the risk factors for DVT?
surgery immobility leg fracture oral contraceptive pill HRT pregnancy long haul flights/travel inherited thrombophilia
how is DVT prevented (same answer as to how is a PE prevented)?
hydration early mobilisation compression stockings foot pumps LMW heparin
who are the low risk groups for thromboprophylaxsis?
<40yrs old
surgery <30 mins ie minor surgery
How do we manage low risk people in terms of thromboprophylaxsis?
early mobilisation
hydration
no chemical - ie ho LMWH
TED stockings if surgical pt
who are the high risk groups for thromboprophylaxsis?
hip and knee, pelvis surgery malignancy people with risk factors prolonged immobility all immobile medical pts many surgical/OBG pts
what are the high risk groups given in terms of thromboprophylaxis
dalteparin (in sheffield, but in other hospitals LMWH is used)
What are the signs of a massive PE?
hypotension
cyanosis
severe dyspnoea
right heart strain/failure
What are the differential diagnoses of chest pain and SOB?
MSK infection malignancy pneumothorax cardiac gastro -eg GORD, oesophageal spasm
what are the sign/symptoms of PE?
breathlessness pleuritic chest pain may have signs/ symptoms of DVT may have risk factors tachycardia tachypnoea pleural rub (heard on auscultation) signs of the precipitating cause
what are the initial investigations and further investigations for PE?
initial: CXR, ECG, ABGs
further investigations: D dimer, CTPA (CT pulmonary angiogram)
what is the treatment for PE?
LMWH and oral warfarin treat cause (in fact warfarin is not really used anymore as needs INR follow up, so DOACs are used now)
what is the diagnostic test of first choice for PE?
ultrasound compression test
