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DVT: A Practical, Rapid Review

Jacob Avila, MD and Anand Swaminathan, MD FAAEM
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16:34
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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00:54

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EM:RAP 2019 September Written Summary 465 KB - PDF

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Scott W., M.D. -

What patients that you diagnose with DVT are you not discharging from the ED on DOACS? What are you using if not DOACS.

Tracy G. -

From Jacob Avila, MD:

I would definitely check with your institution regarding the standard of care at your shop. For me, if they're a relatively low-risk patient (Young person without significant medical comorbidities with a clear and temporary reason for the hypercoagulability) and they're hemodynamically stable and in no acute distress, I'm very comfortable discharging on a DOAC. If they're an elderly patient with multiple medical comorbidities with vital sign abnormalities and no social support at home, I'm most likely admitting. For the patients in between these two extremes, Its basically a case-by-case basis with regards to admit vs. discharge. In these patients I'm considering multiple factors (how close they live to the hospital, social situation, medical problems, pt preference etc) and engaging the patient directly to figure out what is probably the best disposition.

With regards to other meds I'm using if not DOAC's, if I'm discharging, I'm discharging on a DOAC. If they're being admitted, I'm using some sort of heparin and adding/changing to whatever the consultant wants.

Aaron I. -

If you can't see the proximal extent of the DVT (clot as far up the common femoral as you can see) do you adjust your management? Admit even if otherwise young and without significant comorbidities until they can have a more comprehensive imaging study (even if that might be a day or two later)? Immediately move to other imaging to further evaluate clot burden?

J. B. L., M.D. -

Wished you hadn't glossed over Pelvic vein thrombosis - these are really hard to diagnose - especially if you do not have MRI avaiability
Pelvic septic thrombophlebitis is a not un common cause of fever in post partum women, but it can look like a kidney stone or sciatica on clincal exam
Would love to hear more on the subject

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EM:RAP 2019 September Full episode audio for MD edition 228:36 min - 247 MB - M4AEM:RAP 2019 September German Edition Deutsche 113:47 min - 156 MB - MP3EM:RAP 2019 September Farsi Edition Farsi 199:37 min - 274 MB - MP3EM:RAP 2019 September Spanish Edition Español 81:07 min - 111 MB - MP3EM:RAP 2019 September Canadian Edition Canadian 19:03 min - 26 MB - MP3EM:RAP 2019 September French Edition Français 20:28 min - 28 MB - MP3EMRAP 2019 September Board Review Answers 135 KB - PDFEMRAP 2019 September Board Review Questions 710 KB - PDFEM:RAP 2019 September MP3 Files 295 MB - ZIPEM:RAP 2019 September Written Summary 465 KB - PDF

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