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Venous thromboembolism

Facebook: Happy Friday Knight
How to deal with DVT and PE

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Venous thromboembolism

  1. 1. VENOUS THROMBOEMBOLISM: HOW TO DEAL WITH DVT AND PE FACEBOOK: HAPPY FRIDAY KNIGHT
  2. 2. OUTILINES • INTRODUCTION • EPIDEMIOLOGY AND NATURAL HISTORY • CLINICAL MANIFESTATION: DVT AND PE • DIAGNOSIS • MANAGEMENT • PROPHYLAXIS • PRIMARY TREATMENT • SECONDARY PREVENTION
  3. 3. INTRODUCTION • VTE: DVT AND PE • MOST COMMON PREVENTABLE CAUSE OF HOSPITAL DEATH • VIRCHOW TRIAD: VENOUS STASIS, HYPERCOAGULABLE STATE, ENDOTHELIAL INJURY
  4. 4. EPIDEMIOLOGY AND NATURAL HISTORY: RISK FACTORS • AGE: HIGHER INCIDENCE IN ADVANCED AGE • IMMOBILIZATION • TRAVEL • HISTORY OF VTE • MALIGNANCY • SURGERY • TRAUMA • PREGNANCY • OCP AND HORMONAL THERAP • SLE • VARICOSE VEINS • ILIAC VEIN COMPRESSION • POPLITEAL VEIN ENTRAPMENT
  5. 5. CAPRINI RISK FACTOR TOOL
  6. 6. CLINICAL MANIFESTATION: DVT • LEG PAIN: DULL ACHE, TENDERNESS, SWELLING, ERYTHEMA, CYANOSIS, FEVER • PHLEGMASIA CERULEAN DOLENS AND VENOUS GANGRENE
  7. 7. DIAGNOSIS: DVT • D-DIMER • US DUPLEX
  8. 8. CLINICAL MANIFESTATION: PE • OCCLUSION OF PULMONARY ARTERIES: CARDIOVASCULAR COLLAPSE, DYSPNEA, CHEST PAIN, SYNCOPE, HEMOPTYSIS • SIGNS: TACHYPNEA, TACHYCARDIA, RALES, DECREASED BREATH SOUNDS, JUGULAR VENOUS DISTENSION • 50% PRESENTS WITH LEG DVT • HIGH INDEX OF SUSPICION DUE TO SYMPTOMATOLOGY IS NONSPECIFIC AND OVERLAPS WITH OTHER PATHOLOGY: ACS, AD, PNEUMONIA
  9. 9. DIAGNOSIS OF PE • LABORATORY: NONSPECIFIC • EKG: TO RULE OUT MI, S1Q3T3>>RV OVERLOAD • CXR: RULE OUT OTHER DX • CTPA: METHOD OF CHOICE • ECHO: DX SIGNS OF RV DYSFUNCTION
  10. 10. MANAGEMENT: PROPHYLAXIS • ADEQUATE HYDRATION, ANALGESIA, AMBULATION: IMPROVE POSTOPERATIVE RECOVERY • MECHANICAL METHODS • PHARMACOLOGIC METHODS: ALONG WITH RISK STRATIFICATION
  11. 11. MECHANICAL METHODS OF PROPHYLAXIS • PASSIVE: ELASTIC COMPRESSION • ACTIVE: INTERMITTENT PNEUMATIC COMPRESSION
  12. 12. PHARMACOLOGIC METHODS • ASPIRIN • WARFARIN • HEPARINS • FONDAPARINUX • DOACS
  13. 13. TREATMENT OF PE • INITIAL: AIRWAY PROTECTION, OXYGEN SUPPLEMENT • ANTICOAGULATION: SYSTEMIC>>HEPARIN, LMWH, FONDAPARINUX • IVC FILTER • THROMBOLYSIS • SURGICAL THROMBECTOMY

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