Embolism.

Question 1

What are the steps in investigating DVT?

Answer 1

Wells score.
If low: D-dimer and image if positive.
If high: duplex USS.

Question 2

What are the investigation steps for PE?

Answer 2

Low wells score do d dimmers.

CXR
ECG - S1 Q3 T3, RBBB, sinus tachy.
ABG if needed - respiratory alkalosis

CTPA = gold standard
VQ if pregnant.

Question 3

What are the treatment steps of PE?

How long do these last for?

Answer 3

ABCDE and resus.

Provoked - NOAC or LMWH and warfarin (3-5 days or until INR = 2). Then Noac or warfarin for 3 months.

Unprovoked - above for 6 months.

Active cancer - 6m LMWH (fragmin)

Pregnant - LMWH or heparin.

Any circulatory compromise - add Altepase and inotropes, ventilation etc.

Question 4

What are the treatments of DVT’s?

Provoked Distal non pregnant?
Provoked Proximal non pregnant?
Pregnant?
Unprovoked?

Answer 4

PDN- serial imaging plus stockings and activity - continue for three months. Anticoagulation if needed.

PPN- NOAC or LMWH and warfarin - continue for three months.
physical activity and stockings for at least 2 years.

P- lMWH or heparin with stockings.

U- Warfarin and heparin, but re-assess risks and benefits of continuing antcoagulation after 3 months.