DVT Flashcards
(31 cards)
Virchow’s Triad
- Venous stasis
- hypercoagubility
- vessel injury
Where is venous stasis seen?
older pts, post-op pts, chronic heart disease
Where is hypercoaguability seen?
- malignancy
- bleeding disorders
major risks of VTE
- family history
- pregnancy/post-partum
- prolonged immobilization
- estrogen therapy
- obesity
- factor 5 leiden deficiency
clinically significant VTE begin where?
pelvic or lower extremity veins
Small vs large PE presentation
Small PE pt may have slight SOB and tachycardia
Large PE pt will have hypotension, hypoxemia (not the first or more common presentation)
what is a sure sign of a DVT?
Veins are low pressure and therefore collapsible, a non-collapsibility of the vein under pressure is a sure sign of a DVT
signs of chronic venous insufficiency
Permanent leg swelling, black pigmentation on medial malleolus are signs of, chronic venous insufficiency, leads to non healing leg ulcers
MC presentations of PE
- tachycardia # 1
- coughing/coughing up blood
- tachypnea
- SOB
test of choice for PE
CT pulmonary angiogram
pts that cannot undergo angiography w/dye should use ( ) as test of choice
ventilation-perfusion scan
ABG findings for PE
- hypoxemia
- respiratory alkalosis
- Increased Alveolar-Arterial Oxygen gradient
d-dimer is useful for….
- test of exclusion for PE
- high sensitivity
- <500 ng/ml PE excluded
- > 500 order CT angio
what will the CXR look like in a PE pt?
normal at first, hampton’s hump is a rare finding (opacities with convex medial margins)
Westermark sign :
Dilatation of pulmonary vessels proximal to embolism along with collapse of distal vessels, often with a sharp cut off.
EKG findings for PE
S1 Q3 T3, sinus tachycardia
RBBB indicates massive PE
V/Q scanning
Pt inhales xenon and image of lung is taken
Inject macroaggregated albumin with tecnitium, by the time is reaches the lung the endothelial lining break it down so it is no longer radioactive when it leaves the lungs
The two should be matched, if not then it is an indirect sign of PE
Ventilation without perfusion indicates PE, can be done on any type of pt
No dye needed
what is the most accurate test for PE?
pulmonary angiogram, requires catheter into right heart
test of choice for DVT
ultrasound, venous duplex
provoked venous thrombosis
Venous stasis or trauma
unprovoked venous thrombosis
unknown cause, do a hypercoagubility workup
more common in younger pts
1st line of tx in hospital to stabilize clot and further clotting?
reversal
IV heparin,
Reversal - protamine sulfate
when to admit pts and how to monitor?
admit pts w/moderate to severe PE that are hypoxic and HTN, monitor PTT (b/w 60-90) then bridge w/oral therapy then back off the heparin and the pt can go home
what medication is used for pregnant patients or if pt has malignancy (bc they are hypercoaguable)
LMWH-can be given as subcutaneous injection, but you do not follow the PTT for monitoring….less incidence of HIT
