DVT and PE FFM

Question 1

DVT and PE FFM

ASAP:

Answer 1

ASAP: ABCs, IVs, O2, monitor, VS, EKG

Question 2

DVT and PE FFM

Hx/exam:

Answer 2

Hx/exam: OPQRST, SOB, CP, leg swelling, estrogen meds, recent trauma/surg/immob, CA, SAMPLE hx; WOB, card and pulm exam, edema

Question 3

DVT and PE FFM

Labs:

Answer 3

Labs: CBC, BUN/Cr, lytes, gluc, coags, ± D-dimer, ± ABG, EKG
-EKG- sinus tach or non-specific T wave findings (T inversion anteroseptal etc), right heart strain

Question 4

DVT and PE FFM

Rads:

Answer 4

Rads: CXR, ± CTA (get scan regardless of rules if suspicious), ± echo, ± DVT US
CXR: Hampton’s hump: triangular pleural-based density with a rounded apex that points toward the hilum
Westermark sign: dilation of pulmonary vessels proximal to the embolism in association with regional oligemia distally
Echo: D sign: enlarged RV → bowing of septum
McConnell sign: akinesia of mid free wall with normal movement of cardiac apex

Question 5

DVT and PE FFM

Non-Massive PE

Answer 5

Non massive: no signs of clinical instability, hemodynamic compromise or RV strain

Question 6

DVT and PE FFM

Submassive PE

Answer 6

Submassive PE: Acute PE without hypotension but with any of the following:
RV dysfunction or RV dilation on POCUS, elevated BNP, elevated troponin, new ECG changes (RBBB, ST changes, anterolateral T wave
inversions)

Question 7

DVT and PE FFM

Massive PE

Answer 7

Massive PE: sustained hypotension, pulselessness, persistent bradycardia, signs of shock

Question 8

DVT and PE FFM

Phlegmasia cerulea dolens:

Answer 8

Phlegmasia cerulea dolens: painful blue inflammation, cyanotic, petechiae, skin bullae, tense leg

Question 9

Phlegmasia alba dolens:

Answer 9

Phlegmasia alba dolens: painful white leg, massive iliofemoral thrombosis with arterial spasm, leg not tense, when spasm stops will be cyanotic Proximal propagation up to 25%

Question 10

PERC rule questions

Answer 10

PERC rule questions
Use of beta blocker?
Other contraceptives
NuvaRing (Progestin/estrogen)- listed as risk factor in PERC Nexplanon (progestin)- may have small increase risk
Mirena (progestin)- may have small increase risk
Ortho Evra (progestin/estrogen)- risk for VTE
PE prevalence must be 7% or less (Wells < 2) before PERC can be applied

Question 11

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