Wednesday, May 05, 2010

Finals 4: VTE ( DVT and PE)

I find this mneumonic extremly helpful, for the risk factors of VTE.


E - Ex VTE

M - Malignancy

B - Baby? - Pregnant?

O - Oestrogen - Patients on OCP or HRT?

L - Large - Obesity

I - Immune Diseases - Antiphospholipids? or Inborn Congenital Disease - Thrombophilia - protein C or S deficiency?

S - Surgery recently?

M - Mobilization

Lets talk about DVT.

Use Well's score to stratify the risk of having a DVT/PE, and most of the criteria in the scoring are within the mnemonic above. Plus the symptoms of DVT.

Local - Leg pain? Calf tenderness? Erythema? Swelling? Warmth?

Systemic - Fever, Rigors etc.


D-dimers - Rubbish. Also elevated in pregnancy, cancer, surgery, etc.
A positive D dimer with high Well's = diagnosis - treat as DVT plus do a US to confirm.

A negative test with a high Well's score means bring back the patient in a week's time to do US to catch DVT.

A negative test with low Well's score means adios patient.

A positive test with low Well's...i dunno.


Low Molecular Weight Heparin - Enoxaparin - 1.5mg/kg/24 hrs SC. and start warfarin immediately, aiming INR 2-3, for 3 months normally, and 6 months post surgery. Stop enoxaparin when u hit the therapeutic INR and after at least 2 days coz warfarin is prothrombotic in the first 2 days.

Vena Cava filters. Inferior Vena Cava.

Prevention better than cure.


Windchaser said...

good job. keep it up. there's still lots of topic which you need to know by finals. good luck.

ihsan_huhu said...

that's y men dont go for fat chixs

angchoonseong said...

noreen: I KNOW!

ihsan: why? they get dvt? hahahah