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Flashcards in VTED Deck (19):
1

What is meant by Virchow's triad?

Causes of thrombosis:
- Abnormalities in blood flow
- Abnormalities in blood components
- Abnormalities in the vessel wall

1

What are the signs and symptoms of a PE?

Sudden onset
Shortness of breath
Tachypnoea
Tachycardia
Pleuritic chest pain
Low sats
Haemoptysis

3

What investigations should be carried out for a suspected PE?

CXR to rule out other diagnosis
Calculate Wells score
If likely - CTPA
If unlikely - D-dimer, if positive - CTPA
FBC, U&;Es, baseline clotting
ECG

4

What are the key features of a massive a PE?

Hypotension/imminent cardiac arrest
Signs of right heart strain on CT/ECHO, ECG
Consider thrombolysis with IV alteplase

5

What are the key steps in the management of a PE?

ABCDE
Oxygen if hypoxic
Fluid resus if hypotensive
Thrombolysis if massive PE
Fully anticoagulated - LMWH until INR above 2 or for five days (which ever comes first) then switch to Warfarin - continue for at least 3 months

5

What are the complications of thrombolysis?

Bleeding
Haemorrhagic stroke
Reperfusion arrhythmias
Allergic reactions
Hypotension

7

What are the absolute contraindications of thrombolysis?

Haemorrhagic or ischaemic stroke in the past 6months
CNS neoplasia
Recent trauma or surgery
GI bleed in the previous month
Bleeding disorder
Aortic dissection

8

Outline the Wells criteria for the scoring of a suspected PE?

Clinical signs and symptoms +3
PE is number 1 Dx +3
HR > 100 +1.5
3 days of immobilisation (bedbound) or surgery with GA in the past month +1.5
Previous VTED +1.5
Haemoptysis +1
Malignancy +1
PE likely if 4.5 or more

9

What happens in a CTPA?

CT pulmonary angiogram for suspected PE
IV contrast to visualise the pulmonary circulation, it will show up bright white, any mass filling defect will appear dark

10

What are the contraindications for CTPA?

Decreased kidney function
Pregnancy

11

What happens in a VQ scan?

Assesses the ventilation:perfusion ratio to establish whether the pulmonary circulation has been interrupted
In PE, perfusion is decreased

N.b. Uses high dose radiation

12

Describe the use of a D-dimer test alongside the Wells scoring system

With a high Wells score, a D-dimer result will make little difference to Mx.
For a moderate to low Wells score, a negative D-dimer will exclude TED, a positive D-dimer needs further imaging

With a low Wells score, PERC rule can also be assessed to exclude PE

13

What are the major risk factors for VTED?

Previous lower limb orthopaedic surgery
Recent major +/- abdominal surgery
Malignancy
Previous VTED
O&G - third trimester, pre-eclampsia
Fracture, varicose veins, reduced mobility

14

What are the minor risk factors for VTED?

Oestrogen - HRT/COCP
CVS - HF, HTN, CHD
Other- obesity, nephrotic syndrome, IBD

15

What are the presenting symptoms of a DVT?

What investigations are needed?

Sudden onset localised leg pain
Swelling
Increased temperature
Unilateral

15

What is the Wells score for DVT?

2+ DVT likely, one point for each of the following
Active cancer
Paralysis, paresis, or recent plaster immobilisation LL
Recently bedridden 3/7 or major GA surgery in past 12/52
Local tenderness along venous system distribution
Entire leg swollen
Calf swelling > 3cm more than unaffected side
Pitting oedema
Collateral superficial veins
Previous DVT

17

What criteria need to be met to use to Wells score in DVT?

Clinical suspicion of DVT
Not pregnant
Asymptomatic for 72hrs before

18

What further testing should be considered following an unprovoked VTE?

Inherited thrombophilias: factor V Leiden mutation and prothrombin G20210A mutations can be checked at the time of thrombosis

Anti-thrombin 3, protein C and protein S deficiencies should be performed after the event. They are depressed at the time of acute thrombosis and by Heparin and Warfarin

19

What are the appropriate initial investigations in suspected DVT?

Examination
Wells score
If likely - proximal leg vein ultrasound scan
If unlikely - D-dimer- if positive - ultrasound scan