Clinical Presentation
Common presenting symptoms of a DVT
What are unilateral edema or swelling, warmth, tenderness, erythema
Calculator we use on admission to determine need for VTE prophylaxis
What is the Padua Prediction Score (https://www.mdcalc.com/calc/2023/padua-prediction-score-risk-vte)
At least 4 conditions that present similarly to a DVT
What are cellulitis, venous insufficiency, muscle strain/injury, superficial thrombophlebitis, lymphatic obstruction, Baker's cyst, heart failure, drug induced edema
What is peripheral venous duplex/compression ultrasound?
Duration of anticoagulation therapy
What is at least 3 months.
--Longer, often like long if high risk of recurrence (no provoking event, recurrent VTE, active cancer, persistent risk factor)
Primary tool used to determine pre-test probability of a DVT or PE
At least 4 causes of elevated D-dimer other than VTE
What are pregnancy, cancer, infection, recent trauma/surgery, DIC, vasculitis, sickle cell disease?
Contraindications to getting a CTA to diagnose PE
What are pregnancy and severe contrast allergy?
Other relative contraindications include renal impairment, poorly controlled pulmonary or cardiac disease that would make it hard to hold breath or interfere with the necessary heart rate control required for the exam.
Alternative to anticoagulation for stable patients with contraindications
What is an inferior vena cava (IVC) filter
Common presenting symptoms of a PE.
What are
•Dyspnea at rest or with exertion (73 percent)
•Pleuritic pain (66 percent)
•Calf or thigh pain and/or swelling (44 percent)
•Cough (37 percent)
•Orthopnea (28 percent)
•Wheezing (21 percent)
•Hemoptysis (13 percent)
•Hoarseness from a dilated pulmonary artery (Ortner syndrome; <1 percent)
What a d-dimer is good for.
What is, ruling out a VTE in someone with a low/moderate pre-test probability (high sensitivity test, low rate of false negatives)
At least 5 differential diagnosis for a PE
What are heart failure, MI, pneumothorax, pneumonia, pericarditis, acute exacerbations of chronic lung disease, and musculoskeletal pain.
This is necessary to interpret the results of a VQ scan.
What is pre-test probability of PE?
-normal V/Q scan and any clinical probability, no further testing is necessary.
-low-probability V/Q scan and low clinical probability no further testing is necessary.
-high-probability V/Q scan and high clinical probability, PE is diagnosed.
-All other combinations of V/Q scan results and clinical PTPs are indeterminate (inconclusive), and further testing is required.
This is when empiric therapy should be started for PE in a person at average bleeding risk based.
What is:
-Immediately with a high clinical suspicion for PE (eg, Wells score >6),
-If diagnostic evaluation will take > 4 hours for moderate clinical suspicion for PE (eg, Wells score 2 to 6)
-If diagnostic evaluation will take > 24 hours for low clinical suspicion for PE (eg, Wells score <2)
Symptoms may be absent in this proportion of patients with PE.
What is one third?
Screening tool that can rule out PE if all the criteria are negative and pre-test probability </=15%
Echo findings concerning for right heart strain
What are increased R ventricle to L ventricle size ratio, "D sign" (flattened intraventricular septum or even bowing into L ventricle), dilated pulmonary artery, McConnell’s (right ventricular free wall akinesis with sparing of the apex)
Options for anticoagulation
What is:
●Selected oral factor Xa inhibitors (rivaroxaban and apixaban). Others require pre-treatment with heparin
● Low molecular weight (LMW) heparin (Lovenox)
●Fondaparinux
●Unfractionated heparin (UFH)
●Warfarin
Screening tool for PE that can be used in pregnancy
What is YEARS algorithm for PE (or Pregnancy-Adapted Geneva (PAG) score)?
https://www.mdcalc.com/calc/4067/years-algorithm-for-pulmonary-embolism-pe
What is
-systemic thrombolysis (tPA)
-Catheter directed therapies (suction embolectomy, catheter directed thrombolysis)
-Surgical embolectomy