placement teach Flashcards
venous thromboembolism VTE means what
collective term for DVT and PE
occur in 25-50% of patients
risk factors for VTE
increasing age synthetic oestrogen pregnancy trauma sugery past DVT cancer obesity immobility- sitting long time dehydration throbophilais Birth control pills (oral contraceptives) or hormone replacement therapy. Smoking.
metformin used for what
reduces sugars
type 2 diabetics
bladder TCC - transitional cell carcinoma
most common cancer of the bladder
signs and symptoms of DVT
calf warmth
calf tenderness , swelling and erythema
could be painful
a lot asymptotic
can get mild fever and pitting oedema
measure dvt
if obvious 3 cm wider than other leg then thinking of dvt
pulmonary embolism - PE when to suspect
always suspect PE in sudden collapse one-two weeks after surgery
venous thrombi usually from DVT passes into pulmonary circulation and blocks blood flow to the lungs
PE risk factors
same as DVT
signs and symptoms of PE
poor perfusion - breathing symptoms SOB pleuritic chest pain on inspiration acute dyspnea haemoptysis syncope hypotension tachycardia raised JVP gallop rythma , loud p two, right ventricular heave , pleural rub , cyanosis and AF
investigations for a PE
wells score for pe
ECG - normal or sinus tachycardia -RVS,right axis deviation , RBBB,
S1Q3T3 ( pathopneumonic - do PE
CXR - normal and small pleural effusion
ABG- hyperventilation and poor gas exchange and respiratory alkalosis
D-dimer - blood test - low specificity , increased if thrombosis , inflammation and post-op , infection and malgignenacy - if low then not DCT or PE
CTPA - gold standard - ct pulmoary angiogrpahys
DVT prophylaxis
dolteparin 5000 units S/C daily until discharge
exceptions to not give VTE prophylaxis
patients already on warfarin or DOAC - prescribe regular med
active bleeding or hemorrhagic stroke
low plates below 50
their kidney function if lower then eGFR give enoxeparin 20mg
if surgical stocking
is post stroke - flowtrons
if elective hip replacements - dalteprian injection S/c for 10 days rthen aspirin fro 28
if high risk rivaroxaban 10mg
DVT treatments prescribed by weight - treatment dose with dalteparin pre filled syringes
for male of 80kg
15000 units
if patents over 120kg should be given enoxaprin as 1mg/kg twice daily
if renal imapriemten CrCL 15-30 treatment should be enoxaprain as 1mg/kg once daily
massive PE treat with what
alteprase - big clot buster
side effects of dalteparin
bruises on tummy where injection goes
