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Flashcards in DVT & PE Deck (23):
1

What does DVT stand for?
What does PE stand for?

Deep vein thrombosis
Pulmonary embolism

2

What is DVT?

The formation of a blood clot within a deep vein, usually in the leg

3

What are the signs and symptoms of DVT?

Calf warmth
Tenderness
Pain
Swelling
Erythema
Mild fever
Pitting oedema

4

Why is a DVT such a worry?

It can lead to pulmonary embolism, which can be fatal

5

What are the risk factors of DVT?

Increased age
Genetic predisposition
Immobility
Pregnancy

The OC pill, hormone replacement therapy

Trauma
Surgery
Cancer
Obesity
Thrombophilia: blood has a tendency to form clots

6

Investigations for DVT?
Describe them!

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

7

What reasons could cause raised D-dimer?

Inflammation
Pregnancy
Surgery
DVT!

8

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

Compression stockings
Treat the underlying cause

9

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

10

How do you administer Heparin when using it to treat DVT acutely? Why?

Parenteral injection: usually subcutaneous

Quicker access to blood stream

11

How can you prevent DVT in hospital patients?

Early mobilisation
Hydration
Low molecular weight Heparin

12

Only some patients are assessed for their thrombosis risk when they are admitted to hospital.

True or false?

FALSE!

Most patients are assessed for their thrombotic risk so appropriate action can be taken to prevent DVT or PE

13

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

14

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

15

What usually causes PE?

Clot usually arises from a venous thrombosis in the legs or pelvis

16

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

17

What are the risk factors for PE?

Recent surgery esp. leg or abdomen

Thrombophilia
Leg fracture
Immobility
Malignancy
Pregnancy / post partum

18

Symptoms of PE?

Depends on the size and position of the PE

Large PEs are usually fatal

Acute breathlessness
Pleuritic chest pain
Haemoptysis: coughing up blood
Dizziness
Syncope

19

Signs of PE?

Pyrexia
Cyanosis
Dyspnoea
Tachycardia
Hypotension
Raised JVP
Pleural rub
Pleural effusion
Signs of DVT

20

Investigations for PE?
Describe them

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

(V/Q scan)

CTPA: gold standard, will show pulmonary vasculature so shows clot

21

Treatment for PE?

ABCDE resuscitation if critically ill


LMWH for 5 days

Oral anticoagulant for 6 months

IVC filters

In a major PE, consider embolectomy or thrombolysis

22

How can you prevent PE?

Inferior vena caval (IVC) filter that will catch any clots travelling to lungs

Early mobilisation
Hydration
Warfarin

23

ECG changes in PE?

Sinus tachy
ST or T wave abnormalities
R axis deviation
RBBB

Severe PE can show signs of acute ischaemia, such as ST depression