DVT Exam Rated A+ Verified Solutions

DVT Exam Rated A+ Verified Solutions What's Pratt's sign? - Answer- Pain with compression of the calf What's Homan's sign? - Answer- Pain calf with dorsiflexion of the ankle What's Virchow's Triad? - Answer- 1. hypercoagulability 2. immobilization 3. endothelial wall injury What are the RISK FACTORS for DVT? - Answer- "I AM CLOTTED" -Immobilization -A Fib/CHF -Malignancy/MI -Coagulopathy -Longevity (age) -Obesity -Trauma -Tobacco -Estrogen/BCP/HRT -DVT/PE history Others: Pregnancy, Age 75+, Collagen vascular dz, infection, post-partum, HIV/AIDs What are 4 tests you can order for diagnosis of DVT? - Answer- 1. Compression ultrasound (can actually visualize the clot) 2. D-Dimer 500 μg/mL (not sufficient as a stand-alone test) 3. Contrast venography 4. Impedance plethysmography Explain the Law of 8018 - Answer- For IV unfractionated heparin for IMMEDIATE anti-coag -80 mg/kg IV bolus initial dose -18 mg/kg/hr after that How often should you check PTT with administration of unfractionated heparin? - Answer- q6h until it stabilizes to 1.5 - 2x normal (46-70s) What's the dosage for immediate anticoagulation using LMWH/enoxaparin (Lovenox)? - Answer- 1 mg/kg subQ q12h What drug can you use for continued anti-coag? - Answer- Warfarin How is warfarin dosed? - Answer- Load at 10mg or 7.5 mg PO q day for 2-5 days then adjust with INR What's the target INR for warfarin? - Answer- 2.5 How long should you take warfarin following DVT? - Answer- 3-12 months, maintaining INR at 2.5 What percentage of DVT distal to the iliac veins go on to develop a PE? - Answer- Less than 25%!! The more proximal the clot, the more likely it is to develop into a PE What's the "CLASSIC TRIAD" of PE? - Answer- 1. dyspnea/SOB 2. chest pain 3. hemoptysis (less than 14% of pts experience this triad) What're 2 gold standard tests for diagnosis of PE? - Answer- Pulmonary angiography Spiral CT What are 4 methods for diagnosing PE? - Answer- 1. pulmonary angiography 2. spiral CT 3. V/Q study 4. CXR What's the treatment overview for PE? - Answer- 1. Thrombolytic therapy 2. Pulmonary Embolectomy 3. Various filters What's the dosing method for urokinase in PE? - Answer- 4400 units/kg IV over 10 min, then 4400 units/kg/hr for 12 hours What's the dosing method for streptokinase in PE? - Answer- 1.5 million units IV over 60 minutes How long does it take for coumadin to work? - Answer- 3-5 days and causes an initial transient hypercoagulable state (Crozer) What's the Heparin vs Lovenox treatment for DVT? - Answer- Heparin: 5000 units IV bolus, then 1000 units IV q1h and monitor PTT Lovenox: 1mg/kg subQ BID How do you dose heparin for perioperative DVT prophylaxis? - Answer- 5000 units SC 2h prior to surgery 5000 units SC BID until pt ambulates