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SD- Hospital > VTE Lecture > Flashcards

VTE Lecture Flashcards

1
Q

Do DVTs/SVTs form in upper or lower extremitites?

A
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2
Q

DVT/SVTs in upper extremities often form from complications from…

A

PICC or PORT lines

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3
Q

for VTE, rates among highest risk populations can be as high as __% among those not receiving thromboprophylaxis

A

80%

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4
Q

Critical ill
Cancer
Stroke
Pregnancy
MI
Age >75
Previous VTE
Prolonged immobility
Renal failure
Inherited hypercoaguable states

A

high risk populations for VTE

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5
Q

No pharmacotherapy
Early and often ambulation
Mechanicals SCDs

..used for what population of ppl for VTE prevention

A

Non-high risk

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6
Q
  • *pharmacotherapy tx!!** (LMWH or UFH)
  • SQ Lovenox 40 mg daily
  • SQ Heparin 5000 units q12

VTE prevention for what population of ppl?

A

High risk

(no need to continue pharmacotherapy beyond acute stay unless going to rehab)

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7
Q

What must you watch for if a person is on Heparin?

A

Heparin Induced Thrombocytopenia (HIT)

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8
Q

*can be immediate or delayed when on Heparin

50% decrease in platelets should be a RED FLAG!!!

A

Heparin Induced Thrombocytopenia (HIT)

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9
Q

Tx= Stop all Heparin like products

Arixtra=the go to in this situation

A

Heparin Induced thrombocytopenia (HIT)

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10
Q

Dx:
Lower extremity swelling, pain, discoloration

Palpable cord, + Homan’s sign, edema, discoloration

A

DVT

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11
Q

Forcibly and abruptyl dorsiflex the pt’s ankle

Pain in calf and popliteal region= positive sign

A

Homan’s sign (for DVT)

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12
Q

a low probability Well’s Score has a __% negative predicted value

a low probability Well’s score + a negative d-dimer has a __% negative predicted value

A

low Well’s score= 96%

low Well’s score + negative D-dimer= 99%

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13
Q

3+ Wells Score= ?

1-2 Wells Score= ?

0 or less Wells Score= ?

A

3+= high probability

1-2= moderate

0 or below= low

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14
Q

Admit to hospital
Ultrasound to confirm dx
Anticoagulation: IV Heparin or SQ Lovenox for a minimum of 5 days!!!

A

DVT tx

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15
Q

For a DVT, must be on Heparin for at least how many days

A

5 days

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16
Q

for a DVT….

once INR is at goal and parenteral anticoagulation has been administered for a minimum of 5 days, can safely stop parenteral anticoagulation and rely on ____ alone

A

Coumadin

17
Q

Day one for DVT: start Coumadin right away togther with Heparin/LMWH

INR goal=?

A

2.0-3.0

(can load 10 mg daily x3 days then tailor dose to maintain goal)

18
Q

PE
Phlegmasia cerulea dolens

=potential complications of?

A

DVT

19
Q

What is the changing paradigm in DVT management

*is now considered acceptable for monotherapy (no heparin overlap needed)

A

Direct oral anticoagulants (Novel Agents)

20
Q

short half life, 5-9 hours
considered effective immediately
​avoid using if eGFR<30

A

Direct oral anticoagulants (Novel agents)

21
Q

dyspnea + tachypnea at rest or exertion
pleuritic pain
cough
orthopnea
calf or thigh pain +/- swelling
wheezing and coarse breath sounds on exam
hemoptysis (13%)

A

submassive PE

22
Q

dyspnea + tachypnea at rest or exertion
pleuritic pain
cough
orthopnea
calf or thigh pain +/- swelling
wheezing and coarse breath sounds on exam
hemoptysis (13%)

PLUS hypotension (SBP<90)
RV dilation and dysfunction=BAD SIGN

A

MASSIVE PE

23
Q

how do you confirm a PE diagnosis?

A

CT pulmonary angiography

24
Q

When do you do a V/Q scan?

A

If CT is contraindicated

*often cannot get V/Q scans urgently

25
Q

How do you assess the risk level of a PE?

A

EKG and TTE (looking for RV dysfunction)
Follow BP closely (SBP <90 is BAD)

26
Q

If massive PE is amenable to embolectomy (interventional radiology), where should you transfer the pt to?

A

A tertiary medical center

27
Q

Which floor should a massive PE be admited to?
What about a submassive PE?

A

Massive PE= CCU

Submassive PE= med surg with telemetry

28
Q

When should you get a hypercoag. panel (Factor V, Protein C+S) be obtained?

A

AFTER initial treatment period (3 months) and anticoagulation has been stopped

29
Q

What are the indications for an IVC?

A

If the pt cannot use pharm anticoagulnts (bleeding risk)

*if they developed a complication or recurrence on pharmacotherapy alone

30
Q

Do all PEs and DVTs need hospitalizations?

A

No

31
Q

True or False..

For PE and DVT you should start Coumadin and parenteral anticoagulant at same time

A

True

SD- Hospital (10 decks)

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