Chapter 4 - DVT
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A pt presents with pain in his calf. He has a history of smoking and obesity. Your preceptor turns to you and asks "Tell me one clinical and one diagnostic test to help diagnose what the patient might have?" Also tell me at least 6 other risk factors you would want to ask to r/o DVT.
- Homan sign: dorsiflexion of foot causes deep pain in calf
- Venography remains the gold standard for diagnosis
- Other risk factors:
- CHF, MI, stroke, trauma, immobilization, oral contraceptives, hypercoaguability disorder,
Pt presents with serial pressures (toe pressure) of 45. He has wound on toe that is having trouble healing. What would you say his chance of healing it is? Above what level is required for healing?
Probably not a good chance of healing.
- >55mmHg Healing
- 45-55 mmHg range of uncertainty
- <45mmHg No wound healing
At least 30mmHg required for healing a wound on digits.
Patient complains of pain with ambulation in his calf. He says its so bad that he has to stop walking for about 5 min until he can begin walking again. He normally can walk about 75 yards before he must stop. If you were to guess his ABI level what would you guess?
I would guess about .6. The range for intermitant claudication is .5 - .8. Less than .5 is associated with rest pain. And above 1 is calcified vessels.
Your preceptor asks you to name at least 5 non-invasive vascular studies or tests and explain how to perform them.
- 1. ABI
- 2. Doppler
- 3. Elevation dependency test
- Exercise test
- Serial pressures
- 5 Minute reactive hyperemic test
- Perthes test- used to detect deep vein valvular incompetence.
- Trendelenburg's maneuver: Used to differentiate deep and superficial venous incompetence.
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