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29 Cards in this Set

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Virchows Triad
Stasis, injury , hypercoaguable state
risk factors or venous thromboembolism
age > 40 yrs
history of venous thromboemb
surgery with > 30 mins anesthesia
prolonged immonbiliaztion
CVA
CHF
Cancer
frature of pelvis, femur, or tibia
obesity
pregnancy or recent delivery
estrogen therapy
IBD
Genetic
venous thromboembolism:

Preventable deaths associated with _________ rather than treatment failure
missed diagnosis
___% of patients with DVT (and no symptoms) will have a positive lung scan
40
Poor prognosis: Echo with RV hypokinesis in normal ______
systemic B/P
____% of patients with PE had abnormal leg u/s
29
Presentation of PE
Dyspnea
Tachycardia
3.0 points in favor of predicting PE
clinical signs and symptoms of DVT
"Points" for probability of having PE
<2.0 - low
2.0 - 6.0 intermediate
>6.0 high
TEST QUESTION

Degradation products of cross-linked fibrin
D Dimer
Role of D-Dimer
Rule out thromboembolism
TEST QUESTION

If D-Dimer is positive, do you have PE?
D-Dimer is Highly sensitive
Nonspecific
Age, pregnancy, trauma, cancer, postop, inflammatory states


(look this up)
What is significance of a normal Ventilation-Perfusion (V/Q) scan
Rules out Pulmonary Embolism



Radiologist never says it's normal. Always low, int, high probabliity.
TEST QUESTION

Computed Tomography (CT) scan
Sensitivity decreases, as vessel size ________
decreases
TEST QUESTION

Computed Tomography (CT) scan
Negative study not as definitive as _______
Normal V/Q scan
TEST QUESTION

Relative/absolute contra-indication of CT scan:
Renal failure


Contrast media is nephrotoxic
Source of most emboli to Pulmonary arteries
Deep veins of the legs
Patients without signs or symptoms: ____% have DVT
10-20
Patients with Pulmonary Emboli: ____% have DVT
50
Pt with suspected PE:
doc can withhold anticoagulation if .....
Negative study with Negative CT,
Underutilized Gold Standard of diagnosing PE
Pulmonary Angiogram

Invasive
Death rate 0.5%
Major non-fatal complication: 0.8%
Acute Thrombotic state messes up coagulation values how?
Depresses Protein C, Protein S, Antithrombin III
B/c Acute Thrombotic state messes up coagulation values, what do you look for instead?
Lupus anticoagulant
Hyperhomoceistinemia: Factor V Leiden mutation
Treatment of PE
1) Heparin
Loading dose: 5,000 – 10,000 units
Infusion: 18 units/kg/hour (Max 1600 units/hour)
Monitor PTT
Resistance (>50,000 units/24 hr) monitor plasma heparin level, also w prolonged PTT at baseline
2) LMWH
i.e. Enoxaparin (Lovenox) 1mg/kg subQ bid
TEST QUESTION

other treatments of PE
1) Inferior vena cava filters

2) Warfarin 5mg daily
TEST QUESTION

Inferior vena cava filters have the Same mortality with anticoag as anticoag alone
What is Indication for this:
active bleeding, recurrance despite anticoag
TEST QUESTION

How long do you take Warfarin 5mg qd?
6 month after 1st episode,

lifelong after second episode
Warfarin Dosage adjusted to maintain PT. INR ___?
2-3
(Heparin drip until INR gets to 2-3, then put pt on warfarin)

International Normalization Ratio
TEST QUESTION

Another possible treatment for Hemodynamically unstabile pt.

"the clot is so big..."
Thrombolysis


others still (not underlined):
Transvenous catheter embolectomy - suck out the clot
Open embolectomy