thromboembolic disease Flashcards
what is virchows triad
vessel wall damage, venous stasis, and hyper coagulability
what falls under venous stasis
COPD - advanced
hypercoagulability
protein C and S deficiency
antithrombin III deficiency
factor V leiden mutation
CF
pleuritic pain haemoptysis SOB low BP cyanosis sudden death
onset
sudden
what is it scored with
geneva and well score
what are some rare causes
fat, air or amniotic fluid embolism
parasites
foreign material - IV drug user
D-dimer
excludes if low
investigations
FBC, U&E, baseline clotting, D-dimer
ABG
imaging: CTPA or CXR
ECG
what is the first line of imaging
CTPA
who should D dimers be performed on
those without a high risk of PE
ABG
low PaO2 and low or normal PaCO2
what type of resp failure develops
1
what hypersensitivity disease can cause PE
SLE
ECG
S1Q3T3
sinus tachycardia
what is V/Q scan sensitive for
small emboli
what is seen on VQ scan
Perfusion defect is seen before infarction, and perfusion and ventilation mismatch after infarction
acute treatment for PE
O2
IV fluid
thrombolysis
LMWH - dalteparin
PE long term treatment
anticoagulation (warfarin) and IVC filter
DVT treatment
Heparin or LMWH (e.g. dalteparin) and vit K antagonist (e.g. warfarin)
how would you treat a major PR with normal RV function or minor PE
anticoagulate
how would you treat a major PE without normal RV function
anticoagulate and/or thrombolysis
how would you treat a major PE with shock or syncope
thrombolysis or surgery
what are the benefits of graduated compression stockings
reduce incidence of post thrombotic syndrome
what are the benefits of IVC filters
temporarily offered to patients with proximal DVT or PE who cant have anticoagulation treatment
prevent recurrent PE in short term but have complications in long term - used in patients with recurrent
PE complication
sudden death
arrhythmias
pulmonary infarct
pulmonary hypertension
distal DVT
DVT of the calves
proximal DVT
popliteal vein or femoral vein
CF DVT
hot swollen and tender leg
differential of DVT
Popliteal synovial rupture (Baker’s cyst)
Superficial thrombophlebitis
Calf cellulitis
DVT investigation
US - 1st line
CT scan
name 3 complications
Post Thrombotic Syndrome
phlegmasia dolens
CTPH
Post Thrombotic Syndrome
chronic venous insufficiency due to valves in legs destroyed - vein becomes large and flaccid
Post Thrombotic Syndrome CF
pain
oedema
hyperpigmentation
venous ulceration
Phlegmasia dolens
medical emergency where DVT causes obstruction of the arterial flow
Phlegmasia dolens treatmetn
IVC filter
CTPH
blood vessels are blocker/narrowed with recurrent blood clots and constrict. fibrous tissue forms. leads to RHF
