Post Conference Letter, 7/23/08, Part Two
I wanted to add some pearls from Dr. Strayer on Anita’s case from today:
* The literature and expert consensus have evolved over the past decade to favor anticoagulation for below the knee (distal or calf) DVTs. The classic teaching has been that distal DVTs are benign, so ultrasonographers often do not routinely evaluate the calf veins. Because this is no longer thought to be true, consider requesting calf vein assessment if you are suspicious.
* The finding of superficial venous thrombosis warrants a search for DVT. The treatment of superficial vein thrombosis is controversial and ranges from NSAIDs to compression stockings to anticoagulation. There is no consensus on treatment–the key EM issue is to rule out DVT.
* Patients who are moderate or high risk for DVT should be anticoagulated while awaiting ultrasound. If a DVT precipitant is not clear, consider calling hematology to inquire about hypercoaguable state labs to send before administering heparin.
* Many patients with DVT are optimally managed as an outpatient with daily LMWH shots. Visiting nursing services can help.
* Our interface with outside referring physicians is complex, and navigating their requests is fraught with pitfalls. If you don’t agree with their plan, the best course of action is usually an attempt to harmonize over the phone.
Wise words.
Posted
on Thursday, July 24th, 2008 at 6:10 am by Nick. Filed under
Pulmonary Embolism, Ultrasound, Blog.
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