LE pain quiz readings Flashcards
(48 cards)
Homen’s sign
pain in the calf with forced dorsiflexion of the foot (Homans’ sign) is neither sensitive nor specific for DVT.
when do you order a D dimer for sus of DVT?
low or intermediate risk (2 or less points)
ULN of D dimer calculation?
age x 10 ng/mL
What do you get if you have a high pretest probability wells score DVT OR a positive D dimer?
US of LE
treatment of DVT
O2 if needed
fluids if needed
UFH, LMWH (preferred over UFH), or DOAC
what can a severe, non-PE DVT lead to?
phlegmasia cerulea dolens can lead to loss of limb and requires immediate treatment.
treatment of phlegmasia cerulea dolens
affected limb should be maintained at neutral level, constrictive clothing, casts, or dressings should be removed, and anticoagulation should be initiated. Catheter- based thrombectomy or thrombolysis should be discussed with an interventional radiologist, peripheral interventional cardiologist, or vascular surgeon. If this service is not available, consider intravenous thrombolysis.
t/f low risk DVT patients can be discharged with a DOAC
true
what is Peripheral arterial disease (PAD)
ABI of <0.9
high risk individuals for ABI
> 70
50 with DM or other RF
these people should be worked up
when does irreversible changes of peripheral nerves happen in PAD?
4-6 hours
MC diseased arteries in PAD
Femoropopliteal, tibial, aortoiliac, and brachiocephalic.
Femoropopliteal (MC)
Clinical features of arterial limb ischemia
1+ of the six Ps:
Pallor, poikilothermia (coldness), pulseless- ness, paresthesias, and paralysis
what is the earliest symptom of PAD
Pain
When is pain worsened for PAD
elevation of the limb (because you are getting even less of a blood supply)
when is a decreased pulse distal to a vascular obstruction NOT reliable finding
early ischemia, especially in patients with chronic peripheral vascular disease and well-developed collateral circulation
t/f intermittent claudication is a really common finding in late PAD
false
more of an early sign - but as the disease progresses, you lose feeling
what symptoms suggests an arterial embolus in PAD
abruptly ischemic limb in a patient with atrial fibrillation or recent myocardial infarction is strongly sugges- tive of an embolus
what do you exam in PE for PAD
differences in peripheral pulses, capillary refill, and skin findings on the extremities.
what do you order to confirm a PAD in ER setting
Objective bedside testing with a handheld Doppler can document the presence or absence of blood flow in an affected limb.
Duplex ultrasonog- raphy can further be used to detect an obstruction to flow with sensitivity greater than 85%.
Doppler US
peripheral vascular disease, and a ratio lower than ____ is concerning for critical limb ischemia.
0:41:1
gold standard for diagnosing PAD
arteriogram
can define the anatomy of the obstruction and direct treatment of the limb.
what is the managmenet of PAD with potential limb threat
stablize
EKG
UFH followed by IV fluids
vascular surgeon referral
telemetry bed or ICU
if a patient with chronic peripheral arterial disease who lack comorbidities and have no immediate limb threat can be discharged on ____
aspirin 81 mg
325 mg PO before discharge
