GeneralG05ARDSFatMorgangen幻灯片.pptVIP

DVT screening Physical Exam Ascending venography Duplex Ultrasonography Magnetic Resonance Venography Physical Examination Calf Swelling Palpable Venous Cords Calf Pain Homan’s Sign All Unreliable Ascending Contrast Venography Sensitive for detection Invasive Dye Problems (allergies, renal) Injection Site Irritation Poor Pelvic Vein Evaluation Gold Standard *Invasiveness,expense make ACV a poor screening tool Doppler/Duplex Ultrasound Comparable to Venogram Non Invasive No Morbidity Poor Axial (i.e Pelvic) Vein Evaluation Operator Dependent Good Screening Tool Noninvasive, reproducible Magnetic Resonance Venography Non Invasive Good Visualization of Pelvic Veins Difficult in Polytrauma Patient Excellent specificity and sensitivity for suspected DVT Controversial for screening Pulmonary Embolism Clinical Shortness of breath, agitation, confusion Laboratory ? PaO2, ? A-a gradient Diagnostic studies V/Q scans Pulmonary Angiogram, CT PA Ventilation Perfusion Scan Ventilation Perfusion mismatch Results Low probabiltity 15% False Negative Medium Need Angiogram High probability 15% False Positive Screening Tool Pulmonary Angiogram Angiographic Evaluation of pulmonary vascular tree Allows Placement of IVC Filter in same setting if indicated Sensitive - Standard in PE Detection. Diagnostic Treatment PE Anticoagulation Filter for recurrent event despite anticoagulation Thrombectomy Serious Acute PE Patient in extremous Large identifiable PE Treatment DVT/PE Heparin Bolus 10-15K units Continuous Infusion 1000Units/Hr Goal ? PTT 2x Control Prevent Clot propagation and recurrent PE Discontinue when Therapeutic on Warfarin LMWH / Pentasaccharide Mass related dose SQ inj Single daily dose No monitoring necessary Discontinue when Therapeutic on Warfarin Treatment DVT/PE Warfarin INR 2.0-3.0 3-6 Month Duration Contraindicated in: Pregnancy Liver insufficiency Poor Compliance Prolonged Therapy may decrease recurrence rates DVT/PE Outcome No Diagnosis and Treatment 30% M