DVT

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍swellingpain in the ‍rightleft leg

Symptoms include:

‍leg pain

‍leg swelling, ‍rightleftsymmetrical

‍redness

‍warmth over the affected area

‍shortness of breath

‍pleuritic chest pain



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍immobilization

‍hospitalization

‍smoking

‍obesity

‍pregnancy

no history of: ‍previous DVT episodes, ‍recent surgery, ‍hypercoagulable states, ‍cancer

no use of: ‍anticoagulants, ‍birth control pill, ‍hormone replacement therapy





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Knee: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Ankle: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Deep vein thrombosis ‍likelysuspectedpossible

DDx: deep vein thrombosis, superficial thrombophlebitis, cellulitis, muscle strain, ruptured Baker's cyst, lymphedema, compartment syndrome, arterial occlusion, chronic venous insufficiency, post-thrombotic syndrome, pulmonary embolism





PLAN:

Investigations:

- 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

Treatments:

- ‍Anticoagulants

- ‍Acetaminophen

- Compression stockings 20-30 mmHg

- Elevation of the affected limb

Further care:

- 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