Deep Vein Thrombosis

HISTORY:

‍SwellingPain in the ‍rightleft leg for ‍ ‍hoursdays

‍leg pain

‍leg swelling, ‍rightleftsymmetrical

‍redness

‍warmth over the affected area

‍shortness of breath

‍pleuritic chest pain

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Musculoskeletal: joints ‍ ‍normal, ‍no limited ROM

Knee: ‍rightleft: ‍no tenderness on ‍, range of motion ‍fulllimited

Ankle: ‍rightleft: ‍no tenderness on ‍, range of motion ‍fulllimited

Skin: ‍no rash



ASSESSMENT:

‍Deep vein thrombosis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍LFTs, ‍coagulation profile, ‍D-dimer

- Doppler ultrasound of the lower limb

- Investigation for cancer: ‍CT scan of thorax, abdomen, and pelvis, ‍colonoscopy, ‍mammogram, ‍PSA

- Investigation for hypercoagulable states: ‍protein C, ‍protein S, ‍antithrombin, ‍factor V Leiden, ‍prothrombin gene mutation, ‍antiphospholipid antibodies, ‍homocysteine, ‍lupus anticoagulant, ‍anticardiolipin antibodies, ‍heparin-induced thrombocytopenia antibodies, ‍JAK2 mutation, ‍bone marrow biopsy

- ‍Anticoagulants

- ‍Acetaminophen

- Compression stockings 20-30 mmHg

- Elevation of the affected limb

- Referral to internist

- Referral to hematologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as chest pain, shortness of breath, or fainting