Flashcards in DVT & PE Deck (23):
What does DVT stand for?
What does PE stand for?
Deep vein thrombosis
What is DVT?
The formation of a blood clot within a deep vein, usually in the leg
What are the signs and symptoms of DVT?
Why is a DVT such a worry?
It can lead to pulmonary embolism, which can be fatal
What are the risk factors of DVT?
The OC pill, hormone replacement therapy
Thrombophilia: blood has a tendency to form clots
Investigations for DVT?
1. USS doppler
Apply direct pressure to compress the vein with the US transducer.
If the vein compresses completely, then a DVT at this site can be ruled out.
2. D-dimer blood test:
D-dimer will be raised in a DVT.
A normal result rules out DVT, but a positive one does not confirm it
What reasons could cause raised D-dimer?
Treatments of DVT?
Low molecular weight heparin for a minimum of 5 days (short term) parenteral injection
Oral anti-coagulant (warfarin or NOAC) for 3 months
If unprovoked DVT or recurrent, continue oral anti-coag
Treat the underlying cause
Why do you need to give heparin and warfarin for the first few days when treating DVT?
Warfarin is slow acting and is actually pro-thrombotic in the first 48 hrs
You need Heparin to clear the clot quickly
How do you administer Heparin when using it to treat DVT acutely? Why?
Parenteral injection: usually subcutaneous
Quicker access to blood stream
How can you prevent DVT in hospital patients?
Low molecular weight Heparin
Only some patients are assessed for their thrombosis risk when they are admitted to hospital.
True or false?
Most patients are assessed for their thrombotic risk so appropriate action can be taken to prevent DVT or PE
What is a PE?
Clot from venous system travels back to the heart
Enters RA, then RV, then pulmonary artery, then blocks somewhere in pulmonary arterial tree
What is the difference between a thrombus and an embolus?
Thrombus: a clot that has formed in a blood vessel
Embolus: a clot or part of a thrombus that has broken off and travelled in the blood to another part of the body
What usually causes PE?
Clot usually arises from a venous thrombosis in the legs or pelvis
Describe the journey of a clot from a vein in the leg to the lung?
Veins > R atria > R ventricle > pulmonary artery > pulmonary arterial vasculature
What are the risk factors for PE?
Recent surgery esp. leg or abdomen
Pregnancy / post partum
Symptoms of PE?
Depends on the size and position of the PE
Large PEs are usually fatal
Pleuritic chest pain
Haemoptysis: coughing up blood
Signs of PE?
Signs of DVT
Investigations for PE?
Chest X-ray: usually normal
ECG: sinus tachycardia, ST and T abnormalities, R axis dev, RBBB
Blood gases: type I respiratory failure (low PaO2 and PaCO2)
D-dimer: will be raised, but can be raised for other reasons
CTPA: gold standard, will show pulmonary vasculature so shows clot
Treatment for PE?
ABCDE resuscitation if critically ill
LMWH for 5 days
Oral anticoagulant for 6 months
In a major PE, consider embolectomy or thrombolysis
How can you prevent PE?
Inferior vena caval (IVC) filter that will catch any clots travelling to lungs