Hi #Medtwitter: Our 7th Critical Care US Lecture is available!
"Clot or not? US for Lower Extremity DVT Assessment"
Brief 🧵with pearls as usual, video link at the end⤵️ (1/7)
Part of the ongoing @HarvardPulm @MGH_PCCM @PCCSM_BIDMC course!
"Clot or not? US for Lower Extremity DVT Assessment"
Brief 🧵with pearls as usual, video link at the end⤵️ (1/7)
Part of the ongoing @HarvardPulm @MGH_PCCM @PCCSM_BIDMC course!
Why do you care?
Bc despite DVT ppx, 10% of ICU pts still get proximal lower extremity DVTs.
US has been the gold standard for DVT diagnosis since 1989, when a simple 2x2 sens/spec table made it to NEJM.
You can accurately perform these yourself with minimal training! (2/7)
Bc despite DVT ppx, 10% of ICU pts still get proximal lower extremity DVTs.
US has been the gold standard for DVT diagnosis since 1989, when a simple 2x2 sens/spec table made it to NEJM.
You can accurately perform these yourself with minimal training! (2/7)
It's also fast. 2-point compression is probably fine. 3-point even better. Continuous longitudinal eval likely best but takes longer and less likely to yield a DVT when 3-point compression was negative. (3/7)
The major trick is to learn your anatomy.
In this image, 2-point compression would be at points #2 and #5.
3-point would include spot #4.
But you can easily find them all. (4/7)
In this image, 2-point compression would be at points #2 and #5.
3-point would include spot #4.
But you can easily find them all. (4/7)
Remember how to position the patient. Don't compress too hard or too softly. And remember that you don't have to *see* the clot - you just need to be unable to compress the vein. (5/7)
Finally, don't be fooled by lymph nodes or a Baker's cyst. (6/7)
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