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DVT & PE

DVT & PE. Rory Brittain. Clotting / Coagulation Thrombosis  The formation of a clot inside a blood vessel during life. Deep Venous Thrombosis  A Thrombus formed in a vein and secondary inflammation of the vessel wall Pulmonary Embolism

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DVT & PE

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  1. DVT & PE Rory Brittain

  2. Clotting / Coagulation • Thrombosis  The formation of a clot inside a blood vessel during life. • Deep Venous Thrombosis  A Thrombus formed in a vein and secondary inflammation of the vessel wall • Pulmonary Embolism  Blockage of the Pulmonary arteries or their branches by a substance that has travelled via the circulation from elsewhere in the body. Definitions

  3. Virchow’s Triad Hypercoagulability  Endothelial Dysfunction  Haemodynamic Changes (Stasis or Turbulence) Thrombosis

  4. Hypercoagulability  Pregnancy, HRT/Oral Contraceptives, Cancer, Factor V Leiden • Stasis/Turbulence  Immobility, Heart Failure, Atherosclerosis, Aneurysms • Endothelial Damage Surgery/Trauma, Atherosclerosis • Other age >65, BMI >30Kg/m2, air travel? DVT - Risk Factors

  5. Pain in Calf • Swelling • Redness • Engorged Superficial Veins • Leg Pain on Dorsiflexion (Homan’s Sign) DVT - Signs and Symptoms

  6. Two-Level Wells Score

  7. Superficial Thrombophlebitis • Cellulitis • Peripheral Artery Disease Differentials

  8. Ultrasound (Dopler) • D Dimer • Coagulation Screen/LFTs DVT - InvestIgations

  9. Main aim of Treatment is to prevent Pulmonary Embolism • Conservative  Compression stockings for at least 2 years. • Medical  LMWH or Fondaparinux for at least 5 days. Aim for INR >2.5 for 24hrs  Warfarin • Surgical <5% require surgical intervention. Consider in cases of complete venous occlusion. If anticoagulation is contraindicated consider inferior vena caval filter. • Follow Up  Unprovoked DVT consider investigations for thrombophillia/Cancer DvT - MAnagement

  10. Blockage of the Pulmonary arteries or their branches by a substance that has travelled via the circulation from elsewhere in the body. • Possibilities? Thromboembolism Air/Nitrogen  Fat  Amniotic Fluid  Foreign body Pulmonary EMbolism

  11. Signs of previous DVT. • Pleuritic Chest Pain • Shortness of Breath • Haemoptysis • Central Chest Pain • Syncope • Tachycardia • Tachypnoea • Death PE – Signs and Symptoms

  12. V/Q Scanning • CT Pulmonary angiogram • D Dimer • ECG • ABGs PE – Investigations

  13. Two-Level Wells Score

  14. MI/Angina/Heart Failure • Asthma Attack • Pneumothorax Differentials

  15. Oxygen • If hemodynamically stable treat as DVT • If hemodynamically unstable give pharmacological or surgical thrombolytic therapy Streptokinase, rT-PA. Surgical Embolectomy • Circulatory Support. PE - Management

  16. THANKS For Listening!

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