PE/DVT Flashcards
patients with lower extremity DVT often present with what three things?
Redness, swelling and tenderness
What is the initial and most important step in evaluating a possible DVT?
Estimating the clinical likelihood of disease
Let’s say the patient has a low clinical likelihood, what should be done next? What is the patient has a high clinical likelihood, what should be next?
Do d dimer test, and if its negative, rule out DVT. If its positive, go to duplex US
If clinical likelihood is high, go straight to duplex US
What is the most effective preventable treatment in patients with VTE risk factors in the hospital?
Pharmacological prophylaxis
What is the most common therapy for an established DVT?
Most of the time overlap heparin and warfarin for 5 days or until INR is normal between 2 and 3 for two measurements taken 24 hours apart.
Most patients should be treated with anticoagulation for at least 3 months.
If there are strong contraindications to anticoagulation, what should be done?
IVC filter
What is the best treatment for prevention of PE and what not to use?
Pharmacological prophylaxis and don’t use IVC filter
What are the 4 most common symptoms of a PE?
Dyspnea, chest pain, cough and coughing up blood
4 most common physical exam findings for PE?
Tachycardia, tachypnea, lung crackles, and p2 on steroids
What test do we do for clinically stable, low probability of PE?
Check a d dimer, and if negative, then you can rule out PE
What two tests are good for initial imaging testing for PE for high risk probability patients?
CT and V/Q
What to consider if doing a V/Q scan for a PE?
It doesn’t visualize the clot, just measures pulmonary blood flow, and there are many cardiopulmonary or cardiac diseases that can affect pulmonary blood flow.
3 extreme clinical manifestations of PE?
Right heart dysfunction, infarction and cardiac arrest
Therapy for current PE?
Heparin and warfarin for 5 days or until INR is normal at 2-3 on two separate measurements within 24 hours.
What is an alternative for a massive PE?
If patient has massive PE and unstable, go in and surgically take that thing out.
Everything under the wells criteria gets how many points and what is the only thing that drops the score and how many points does it drop?
Everything gets a point.
If there is an alternative diagnosis to DVT patient score gets negative 2 points.
A score of 0 or lower is associated what what, what do we do next and how should the approach/treatment proceed?
Unlikely for DVT
Do a d dimer test, if negative rule out DVT. If positive, do US.
If negative on US, rule out DVT. If positive, anti-coagulate
What about a score of 1-2?
Moderate risk.
Everything is the same as a score of 0 or lower just do a high sensitivity d dimer test.
What does a score of 3 or higher suggest?
Likely DVT
What is the point value for the following 7 variables for the wells criteria for PE?
Signs of DVT, alternative diagnosis of DVT not likely, Cancer, previous PE or DVT, coughing up blood, HR over 100, immobilization or recent surgery?
3 3 1 1.5 1 1.5 1.5
What is the three tiered clinical probably assessment for wells criteria for PE? What is the modified wells criteria for PE?
Score over 6 is high
2-6 is medium
Less than 2 is low
Over 4 is PE likely, 4 and under unlikely
What is the one pro and con to using d dimer test?
Negative test makes DVT unlikely but a positive test is not diagnostic of DVT
2 pros of CT angiography and 3 cons?
High sensitivity and specificity
Gold standard for intermediate risk
Allergies because contrast
Expensive
Radiation
1 pro and 1 con to using v/Q scanning?
High sensitivity but low specificity
3 pros of doppler venography?
Cheap, easy and no radiation
1 pro and 3 cons to contrast venography?
See anatomy and lumen very good
Contrast, so allergies
Painful
Invasive
What diseases are we thinking of hyper coagulable states?
Deficiencies in factors that are anti clot, so like antithrombin, protein c, protein s, Leiden v, prothrombin mutation
5 acquired causes of hyper coagulable?
Cancer, smoking, oral contraceptives, pregnancy, PCV
