DVT - case study in Acute Flashcards

1
Q

Questions to ask about for DVT

A
  • When was this noticed?
  • Chest pain?
  • SOB?
  • Insect bites/trauma to leg?
  • Unilateral pain?
  • Mobilising?
  • Cancer?
  • Previous DVT/PE?
  • Recent surgery/immobilisation for 3 days?
  • Pregnancy
  • Medication?
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2
Q

Algorithm for DVT suspected?

A
  • First calculate Wells score
  • If score 2 points or more = likely
  • If 0/1 = unlikely
  • Likely –> vein USS leg if results not within 4 hours, offer D-dimer, interim anticoag and USS within 24hrs
  • Unlikely –> D-dimer, if cannot have results within 4hrs, interim anticoag
    If +ve –> offer USS within 4hrs, if not continue anticoag and get one in 24
    If -ve D dimer = not DVT
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3
Q

Tests for DVT

A
  • D-dimer
  • ECG - PE?
  • FBC, U&E, LFT
  • PT & APTT
  • USS leg veins
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4
Q

Treatment for DVT

A
  • Apixaban or Rivaroxaban (if not LMWH) within 4 hrs
  • If use LMWH follow with dabigatran or edoxaban after 5 days
  • another option is LMWH and warfarin for 5 days
  • Long term treatment is oral anticoagulant eg DOAC, dabigatran, or warfarin
  • Treatment is for 3 months in provoked (can find cause) if unprovoked may be longer
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5
Q

Preventative measures for DVT

A
  • Mobilising after op
  • Compression stockings
  • Intermittent pneumatic compression
  • LMWH for those at risk in hospital
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6
Q

What is part of DVT Wells score?

A
  • Cancer = 1
  • Bedridden more than 3 days or major surgery within 12 weeks = 1
  • Calf swelling more than 3cm to other leg = 1
  • Collateral superficial veins visible = 1
  • Entire leg swollen = 1
  • Localised tenderness along deep veins = 1
  • Pitting oedema confined to affected leg = 1
  • Paralysis, paresis or recent plaster of lower extremity = 1
  • Previous DVT documented =1
  • Alternative diagnosis as or more likely = -2
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7
Q
A
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