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

1. VENOUS THROMBOEMBOLISM:
HOW TO DEAL WITH
DVT AND PE
FACEBOOK: HAPPY FRIDAY KNIGHT

2. OUTILINES
• INTRODUCTION
• EPIDEMIOLOGY AND NATURAL HISTORY
• CLINICAL MANIFESTATION: DVT AND PE
• DIAGNOSIS
• MANAGEMENT
• PROPHYLAXIS
• PRIMARY TREATMENT
• SECONDARY PREVENTION

3. INTRODUCTION
• VTE: DVT AND PE
• MOST COMMON PREVENTABLE CAUSE OF HOSPITAL DEATH
• VIRCHOW TRIAD: VENOUS STASIS, HYPERCOAGULABLE STATE, ENDOTHELIAL
INJURY

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. CAPRINI RISK FACTOR TOOL

6. CLINICAL MANIFESTATION: DVT
• LEG PAIN: DULL ACHE, TENDERNESS, SWELLING, ERYTHEMA, CYANOSIS, FEVER
• PHLEGMASIA CERULEAN DOLENS AND VENOUS GANGRENE

7. DIAGNOSIS: DVT
• D-DIMER
• US DUPLEX

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

10. 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

12. MANAGEMENT: PROPHYLAXIS
• ADEQUATE HYDRATION, ANALGESIA, AMBULATION: IMPROVE POSTOPERATIVE
RECOVERY
• MECHANICAL METHODS
• PHARMACOLOGIC METHODS: ALONG WITH RISK STRATIFICATION

13. MECHANICAL METHODS OF PROPHYLAXIS
• PASSIVE: ELASTIC COMPRESSION
• ACTIVE: INTERMITTENT PNEUMATIC COMPRESSION

15. PHARMACOLOGIC METHODS
• ASPIRIN
• WARFARIN
• HEPARINS
• FONDAPARINUX
• DOACS

16. TREATMENT OF PE
• INITIAL: AIRWAY PROTECTION, OXYGEN SUPPLEMENT
• ANTICOAGULATION: SYSTEMIC>>HEPARIN, LMWH, FONDAPARINUX
• IVC FILTER
• THROMBOLYSIS
• SURGICAL THROMBECTOMY