Venous thromboembolism

Question 1

2 types of venous thromboembolism VTE

Answer 1

-pulmonary embolism- clot in lungs (PE)
-deep vein thrombosis- thrombus in leg (DVT)

Question 2

Thrombus-
Embolus-

Answer 2

-blood clot
-anything that moves through a vessel until the vessel gets too small to pass (usually due to a thrombus)

Question 3

DVT pathophysiology

Answer 3

Thrombosis
-damaged and warped valves
-causes blood to flow in both directions and blood to accumulate in vein
Embolus
-blood moves slowly causing a clot or thrombus to form
-the clot can then break off and travel in blood as an embolus

Question 4

VTE risk factors and what causes the risk factors

Answer 4

Virchow’s triad thrombosis
1. Hypercoagulability (blood clots easily)- caused by surgery, pregnancy, cancer, infection etc
2. Vascular damage (damage to vessel wall)- cellulitis, atherosclerosis (fat deposits), venepuncture, inflammation
3. Circulatory status- immobility, venous obstruction, varicose veins, atrial fibrillation

Other risks
-over 60
-male

Question 5

DVT signs and symptoms

Answer 5

-pain/ tenderness
-reddening/ discolouration
-swelling
-difficulty weight bearing
-leg tiredness

Question 6

Wells scoring for DVT

Answer 6

0-1= low probability of DVT
1-2= moderate probability
3-8= high probability

Question 7

DVT pathway (different patient groups)

Answer 7

Pregnant or given birth 6 weeks ago- referred for same day assessment
Low to moderate wells score- referred for same day assessment
High wells score- need to be seen within 4 hours

Question 8

High wells score treatment

Answer 8

-need ultrasound
-if not possible need D-dimer test followed by therapeutic anticoagulation
-advice from GP for direct referral to DVT clinic

Question 9

Signs of different PE

Answer 9

Multiple small PE- progressive breathlessness, non emergency
Segmental emboli with pulmonary infarction- chest pain, no circulatory compromise
Major PE in larger branches- sudden onset shortness of breath, tachycardia and hypotension
Massive PE- LOC, tachypnoea, can be fatal

Question 10

Symptoms PE

Answer 10

-dyspnoea
-pleuritic chest pain (sharp, worse on inhalation, localised)
-cough
-haemoptysis (blood in sputum)
-syncope (fainting)

Question 11

Signs PE

Answer 11

-tachypnoea- greater than 20
-tachycardia- greater than 100
-SPO2 less than 92%
-signs of DVT
-low grade fever

Question 12

PE pathway

Answer 12

-time critical in primary survey, correct them first eg. blocked airway etc
Not time critical
-specific assessment
-oxygen if needed
-position of comfort, often sitting
-ECG
-pain relief (avoid entonox if one of differentials is pneumothorax, avoid morphine if shocked)
-transfer rapidly to hospital with pre alert