Recognizing Deep Vein Thrombosis Symptoms: Case Discussions & NICE Guidance
Explore a case study of a 53-year-old man with possible DVT symptoms, including redness and swelling in the calf, and the medical process involving assessments like the Wells score and Doppler ultrasound. Learn key messages from NICE guidance on DVT evaluation, along with insights into spotting signs of DVT and managing an unwell baby with Group B Strep Sepsis.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
Case Discussions Significant Events May 2023
DVT or not? 53 year old man (psoriatic arthritis, sarcoidosis, obesity, erythema nodosum) 10thMarch 2023 patient reports that left calf is red and swollen for past 2 days. Similar episodes twice in the past which responded to antibiotics (cellulitis) antibiotics prescribed 21stMarch 2023 ongoing swelling left calf, both lower legs erythematous D dimer reported 623ug/L, Wells score -1 managed as cellulitis 4thApril 2023 leg swelling improving but still has erythema 12thApril 2023 some reported improvement, further antibiotics issued 27thApril 2023 some improvement but ongoing lower leg swelling clinician concerned about possible DVT US requested, Apixaban commenced
DVT or not? 28thApril 2023 Doppler US shows no evidence of thrombosis, but some evidence of oedema consistent with inflammation/infection D-dimer Well s score
Key messages from the new NICE guidance New NICE guidance published in 2020 says (NICE NG 158, 2020): The DVT guidance is unchanged: if a DVT is suspected, do a Wells DVT score: If a DVT is UNLIKELY (Wells DVT score 1), do a D-dimer; if positive, do a proximal leg ultrasound. If a DVT is LIKELY (Wells DVT score 2), do a scan; if this is negative, do a D- dimer.
Symptoms and signs of a DVT The NICE guidance starts with "If DVT suspected...", with no mention of what features might make us think about DVTs. A Lancet review helpfully listed the following features, with frequencies (Lancet 2021;398:64): Leg pain (80 90% of those with a DVT). Swelling (80%). Localised tenderness on palpation (75 85%). Prominent collateral superficial veins (30%). Redness (25%). A BJGP paper also helpfully reminded us that in a low-risk patient with no clinical signs, 97% will not have a DVT (BJGP 2021;71:379). The symptoms and signs of pulmonary emboli are discussed after the summary of the NICE guidance.
Unwell Baby 6 week old baby 17thApril 2023 telephone triage unwell for past few days, crying all the time, poor feeding invited to attend surgery 17thApril 2023 attended surgery (but different site to that intended). Seen by ANP (had available appt) concerns about distress/dehydration GP asked to see patient and patient admitted to hospital 6 day hospital admission (diagnosis Group B Strep Sepsis) good recovery
Unwell Baby Spotting the sick child One surgery 3 sites Asking for help? Readiness to help?
Whose nail clippings are they? 85 year old lady 29thMarch Phone call to GP ? Fungal nail infection 6thApril patient attended surgery for toenail clippings 11thApril microscopy no fungal elements seen 11thApril patient asked to submit photo pf nails submitted 25thApril patient referred to podiatry for assistance to cut toenails 25thApril mycology culture positive 2ndMay task sent to admin to request telephone appt to discuss toenail booked for 19thMay 3rdMay phone call to patient about another issue toenail result noted and prescription (amorolfine) issued appt for 19thMay cancelled
Who to see? 30 year old man (moderate learning disability) 21stApril 2023 contacted GP practice on-line sore penis, skin slightly cracked and hurts to wee ongoing for a month 22ndApril 2023 GP triage to invite patient for WISH (sexual health) appointment appointment arranged via reception 26thApril 2023 Patient attends WISH appt with HCA but patient declines swabs for STIs 26thApril 2023 GP in adjacent room asked to see patient no recent history of SI, possible fungal infection/dry skin on shaft of penis, daktacort prescribed
How are you feeling? 70 year old man with 4 week history of breathlessness (sudden onset) 18thApril seen in surgery (ANP) clinical exam unremarkable for bloods, ECGH, CXR 25thApril CXR completed normal 27thApril bloods taken normal 4thMay ECG shows bradycardia and heart block (pulse 37/min) ECG shown to GP who advised patient to be added to duty dr list patient left the building 4thMay patient phoned by duty dr advised to attend A&E (friend to take him) 5 Day hospital stay and Pacemaker fitted good outcome
