Exam 4: DVT and PE Flashcards
(49 cards)
What are the three components of Virchow’s Triad regarding DVT?
Stasis + Hypercoaguability + Vessel wall injury
What is the biggest risk for developing recurrent VTE?
previous thrombotic event
The most common chronic conditions that lead to increased risk for VTE are…
Malignancy
Antiphospholipid Ab Syndrome
Myeloproliferative disorder
What common causes of transient state are linked to increased VTE risk?
surgery, trauma, immobilization or a central venous catheter
What female specific factors commonly increase the risk for developing VTE?
pregnancy, hormonal contraceptives
What are the two most common inherited risk factors for VTE development?
Factor V Leiden mutation and prothrombin gene mutation
A patient complains of unilateral pain of the right lower extremity. The patient was recently discharged from the hospital after having a bone tumor removed.
What do you expect to find on physical exam?
warmth, erythema and swelling > 3 cm of affected lower extremity.
(+) calf pain and homan’s
A wells score of 3 or more indicates what?
high probability of DVT
A wells score of 1-2 indicates what?
moderate probability of DVT
A patient you suspect of DVT scores a 1 on the Well’s criteria. What test should you order and why?
D-Dimer only used to r/o DVT.
A patient with a wells score of 0 is referred to your service. The patient was recently hospitalized, is elderly, has hx of malignancy and renal insufficiency.
D-Dimer is elevated. Is this concerning for DVT?
no. d-dimer is commonly elevated in pts with this presentation
The D-Dimer is only used to r/o DVT for what reason?
it is not a specific test for DVT. It should not be performed if expected to be positive (wells > 1)
A patient presents with a wells score of 0 and a negative D-dimer. Patient is positive for lower extremity swelling and erythema. Do you still suspect DVT?
no.
A patient presents with hx of immobilization, tenderness in lower extremity, calf swelling > 3cm and pitting edema. What is the Well’s score and what test is ordered to confirm suspicion of DVT?
Wells 4
order compression ultrasound to show loss of vein compressibility
You have one patient who has a positive ultrasound for popliteal DVT, and one patient positive with a distal DVT.
Do both of these patients receive anticoagulation?
Proximal - Absolutely
Distal: if symptomatic
Your patient has a positive DVT in the iliac vein. What is the treatment and for how long should treatment continue?
anticoagulation minimum 3 months if provoked, often 6-12 months if unprovoked.
you’ve started a patient with a DVT on coagulation. What should coincide with anticoagulation therapy?
early ambulation if sxs are under control
What is the common cause of upper extremity DVT?
secondary to catheter placement
a patient presents with dull pain along a vein, induration, redness. Patient is negative for edema. Hx of PICC line, IVDU and hypercoagulability. Do you suspect this to be a DVT? How do you tx this?
No. Likely superficial thrombophlebitis.
tx w/ local heat, nsaids.
what is the main goal of therapy when treating a DVT?
Preventing development of pulmonary embolism
Pulmonary embolism can be classified in one of what 4 ways…
Hemodynamic stability: stable or unstable
Temporal pattern: acute, subacute, chronic
Anatomic location: saddle, lobar, segmental, subsegmental
Presence of Sxs
a systolic blood pressure of < 90mmHg or drop of 40 from baseline for 15 minutes indicates what type of PE?
massive PE, hemodynamically unstable PE
A patient presenting with dyspnea, pleuritic pain and hemoptysis should concern you for what?
PE…classic presentation of PE
A post-operative patient presents c sudden onset of tachypnea, is tachycardic, apprehensive and complains of pleuritic chest pain, expecially while coughing. What should you immediately suspect?
PE
