Blueprints in Cardiology [USMLE Steps 2,3] by E. Awtry, et al.,

By E. Awtry, et al.,

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Additional resources for Blueprints in Cardiology [USMLE Steps 2,3]

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It should be noted, however, that veins distal to a proximal venous thrombosis, especially distal to iliofemoral venous thrombosis, may have high venous pressures as the result of the proximal occlusion and may be resistant to compression even though no thrombus exists in that vein segment. 6). Dilated veins and ­­ enlarged tributary veins (collaterals) are also ­v isible indicators of acute DVT. The Doppler signal adds valuable information, especially when ­respiratory phasicity is lost, when spontaneous venous signals cannot be appreciated, and when augmentation (compressing the leg below) is abnormal.

This significantly reduces postoperative bleeding without reducing efficacy. If fondaparinux is delayed ≥8 hours after the operation, it offers significant advantage over LMWH in orthopedic patients. 0] Fondaparinux Better Study Hip fracture17 THR18 undergoing general surgery. Over 800 patients were r­ andomized to receive IPC alone or IPC plus fondaparinux. 3% in patients receiving IPC alone. 6% vs. 006), no bleeding episode was fatal or involved a critical organ. Similar to trials in orthopedic surgery, the timing of postoperative fondaparinux administration correlated with bleeding complications.

2 VTE risk assessment tool Low risk (0–1) 1 risk factor equivalent Moderate risk (2–4) 2 risk factor equivalents High risk (≥5) 3 risk factor equivalents Age 40–59 Age ≥ 60 History of DVT/PE Bed confinement > 48 hours (history of or anticipated) Trauma (reason for hospitalization) Acute spinal cord injury (within past 6 weeks) Varicose veins (observed or diagnosed) Acute stroke Any leg edema/ulcer/stasis Joint replacement (admit Dx) Obesity (BMI ≥ 30) Hip fracture (admit Dx) MI (current/past 2 weeks) Malignancy (active) CHF (admit Dx) Pelvic surgery (gynecological, colorectal, GU) Inflammatory bowel disease (admit Dx) Pelvic/long-bone fracture (admit Dx) Crystalloids (>5 L/24 hours) Hypercoagulable state (thrombophilia) Confining travel > 4 hours (within past 2 weeks) Family history of DVT (siblings, parents, children) Pregnancy/postpartum (1 month) Severe COPD (admit Dx) Severe infection/sepsis Estrogen use (ERT and contraception) Operation > 2 hours duration (this hospitalization) Count boxes checked above Count boxes checked above Count boxes checked above Multiply ×1 Multiply ×2 Multiply ×3 1st column total = 2nd column total = 3rd column total = Risk score = sum of all three columns Note: BMI, body mass index; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; DVT, deep vein thrombosis; Dx, diagnosis; ERT, estrogen replacement therapy; GU, genitourinary; MI, myocardial infarction; PE, ­pulmonary embolism; VTE, venous thromboembolism.

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