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?
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
3
Q
Tests for DVT
A
- D-dimer
- ECG - PE?
- FBC, U&E, LFT
- PT & APTT
- USS leg veins
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
5
Q
Preventative measures for DVT
A
- Mobilising after op
- Compression stockings
- Intermittent pneumatic compression
- LMWH for those at risk in hospital
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
7
Q
A