venous thromboembolism Flashcards Preview

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Flashcards in venous thromboembolism Deck (20):
1

partial or complete occlusion of deep vein by thrombosis

DVT

2

blocking of pulmonary artery by thrombus (usually from popliteal, femoral, iliac veins)

PE

3

risk factors for VTE

age
previous thromboembolism
obesity
pregnancy
postpartum period
malignancy
inherited thrombophilias
OCP
exogenous estrogen tx
immobility, trauma, surgery

4

virchow triad - promote development of thrombosis

stasis
vascular damage
hypercoaguable

5

leg pain or swelling

symptoms of DVT

6

SOB
pleuritic chest pain
cough
tachypnea
rales
tachycardia

symptoms of PE

7

acute leg pain and swelling diff dx

superficial thrombophlebitis (COMMON): erythema, induration, tender superficial vein caused by inflammation and thrombus (long saphenous vein), 20% have DVT
trauma: fracture, muscle tear, unilateral
cellulitis (COMMON): dermis and subq infection via group A strep or s. aureus, risks: chronic edema, minor trauma, dermatosis
dermatitis (COMMON): pruritis, secondary edema, local histamine

8

chronic leg pain and swelling diff dx

chronic venous insufficiency (COMMON): bilateral, bad valves in saphenous veins, +/- hereditary
postphlebitic syndrome: DVT can damage valves causing chronic edema, ulceration
CHF (COMMON): low CO, systemic venous congestion
pretibial myxedema: NON-pitting, hypothryoidism (weight gain, fatigue, cold intolerance)
hypoalbuminemia (malnutrition, liver failure, GI or renal loss of albumin): bilateral, PITTING edema, stimulates Na retention

9

specific for DVT

history of recent surgery or immobilization for more than 3 days in past 4 weeks

10

sensitive for DVT

pitting edema
calf pain
swelling

11

fever think

PE or systemic infection

12

hypotension, pulmonary edema, cyanosis

PE
CHF
dysrhythmia

13

syncope

PE
dysrhythmia

14

SOB, tachypnea and/or chest pain

PE
CHF
dyshrythmia

15

limitations of duplex venous US

operator dependent
can't distinguish acute vs chronic DVT
can't detect pelvic or calf DVT well
bad if edema or obese

16

if high risk for DVT based on clincial decision rule but negative U/S follow-up with

D dimer or repeat U/S
4-7 days later, educate about warning signs

17

use clinical decision rule + venous U/S to diagnose

DVT

18

elevated D dimer -fibrin degradation product

increased risk of DVT

19

positive venous U/S rules in DVT if high risk patient
negative D dimer rules out DVT in low risk patient
positive D dimer also rules in DVT if venous U/S normal in high-risk patient

tests for DVT

20

negative D-dimer

doesn't rule out DVT