Ebook Ultrasound for surgeons: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Ultrasound for surgeons: Part 2
Ebook Ultrasound for surgeons: Part 2
Chapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2tem can be dillicuh. I lislory and physical examination have a limited role in the accurate diagnosis ol venous disease. Further diagnostic imaging is frequently required. Invasive techniques such as venography have been proven to be reliable and have become the “gold standard” against which all oth Ebook Ultrasound for surgeons: Part 2er techniques are measured. However, rhe expense and potential risks of such invasive studies have led to the development of noninvasive methods. ThroEbook Ultrasound for surgeons: Part 2
ugh recent technological advancements, ultrasound has emerged as a reliable and useful tool in the evaluation OÍ the peripheral venous system. Ils accChapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2the "gold standard".One of the most common manifestations of peripheral venous disease in surgical patients is venous thromboembolism. It is a dreaded complication seen in every surgical specialty; however, certain patient populations have been identified that seem ro be at greater risk. The morbidi Ebook Ultrasound for surgeons: Part 2ty and mortality associated with this disease process have been well described. Intuitively, many of these patients are sicker and often are found inEbook Ultrasound for surgeons: Part 2
critical care units. Thus, many studies have examined the role of aggressive measures to prevent this serious complication in these potentially criticChapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2hed. Some studies advocate routine screening in select populations considered to be at extremely high risk for venous thromboembolism. The imaging modality most commonly used for this routine screening has been ultrasound, ihis chapter will review the role of ultrasound in screening and diagnosing t Ebook Ultrasound for surgeons: Part 2his peripheral venous disease in select surgical patients. It will also review some of the important technical concepts in performing and interpretingEbook Ultrasound for surgeons: Part 2
an adequate study.History and IndicationsVenous thromboembolism is often clinically silent, and physical examination is an insensitive tool in the diChapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2E) in select patients. This underscores the necessity for prophylaxis in these select patients. The 5th American College of Chest Physicians (ACCP) Consensus Conference on Antithrombotic Therapy report on the prevention of venous thromboembolism identifies risk factors and patient groups considered Ebook Ultrasound for surgeons: Part 2to be at high risk.' Any surgical procedure or disease process that exposes the patient to any of the risk factors described by Virchow’s triad of staEbook Ultrasound for surgeons: Part 2
sis, endothelial damage, and hypercoagulability places that patient in a high risk population. Patients undergoing majorUltrasound for Surgeons, editeChapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2ell as patients with congestive heart failure, myocardial infarction, stroke, and fractures of rhe pelvis and lower extremities are all ar risk for prolonged immobility. Prior venous thrombosis and the presence of indwelling venous catheters result in endothelial damage and increase the risk ol furt Ebook Ultrasound for surgeons: Part 2her thromboembolism. Many clinical conditions predispose patients to a hypercoaguable state. Among these are the presence of cancer, estrogen use, andEbook Ultrasound for surgeons: Part 2
several hemostatic abnormalities including lupus anticoagulant, protein c and protein s deficiencies, antithrombin 111 deficiency, and factor V IxidcChapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2to be as high as 1.6% (fatal PE: 0.9%). Current recommendations for prophylaxis include rhe use of low dose unfractionated heparin (LDƯH), low molecular weight heparin (LMWH), or intermittent pneumatic compression devices (IPC). In patients undergoing orthopedic surgery for total hip or knee replace Ebook Ultrasound for surgeons: Part 2ment as well as hip fracture, the incidence of DVT and PE are significantly higher (84% and 24% respectively). Current recommendations for prophylaxisEbook Ultrasound for surgeons: Part 2
include LMWH or warfarin. The incidence oí DVÌ in patients suffering from myocardial infarction or stroke was noted to be as high as 24% íor MI and 6Chapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2d I.MVVI I are clicctivc.Patients sustaining multiple traumatic injuries often have a combination of prolonged immobility, endothelial injury, and a hypercoaguable state. This places trauma patients at significant risk for thromboembolic complications. A recent study demonstrated an incidence of .58 Ebook Ultrasound for surgeons: Part 2% for all DVT and 18% for proximal DVT in 349 trauma patients.7 Other studies have cited the incidence of fatal PE to be as high as 2%, and PE is theEbook Ultrasound for surgeons: Part 2
third most common cause ol death in trauma patients who survive beyond the first day. Additionally, thromboembolic complications account for up to 9% Chapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2he prevention and detection ol DVT and PE in this select population appears to be warranted. A large prospective, randomized study compared the efficacy and safety of LDƯH versus LMWH in select adult trauma patients.5 Patients receiving LDƯH had a significantly higher incidence of all DVT as well as Ebook Ultrasound for surgeons: Part 2 proximal DVT. There was no significant difference in bleeding complications. Thus current recommendations from the ACCP Consensus Conference report sEbook Ultrasound for surgeons: Part 2
uggest the use of LMVVH in trauma patients unless contraindicated. Mechanical (IPC) devices are recommended for patients who cannot be anticoagulated.Chapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2s with spinal cord injury, traumatic brain injury, pelvic and lower extremity fractures, advanced age, and cither venous injury or indwelling venous catheters are at significantly increased risk. Many groups have advocated the use of surveillance ultrasound in this population to detect clinically oc Ebook Ultrasound for surgeons: Part 2cult DVT Knudson and colleagues followed 251 trauma patients with serial duplex exams.4 They noted an incidence of 6% for lower extremity DVT, of whicEbook Ultrasound for surgeons: Part 2
h the majority were clinically silent. Through risk factor analysis in their own patient cohort as well as a review of the existing literature, they iChapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2serial ultrasound exams in these patients allowed for prompt recognition and treatment of occult780Ultrasound for SurgeonsDVT Velmahos er al reported an incidence of 13% among 200 select trauma patients, despite prophylaxis.5 All patients underwent serial Doppler exams weekly. Most of the DVT s were Ebook Ultrasound for surgeons: Part 2 identified within the first two weeks of hospitalization, and most of them were identified in patients admitted to rhe critical care unit. They conclEbook Ultrasound for surgeons: Part 2
uded (hat surveillance Doppler exams arc justified in all critically injured patients. Olliers have argued that the sensitivity of noninvasivc imagingChapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2ries or lack ol patient cooperation. Costs ol serial exams may be prohibitive. Spain and colleagues performed a retrospective review of 280 trauma patients considered to be high risk by retrospective stratification.6 They cited a DVT incidence of 5%, and a nonfatal PE incidence of 1.4%. Diagnosis wa Ebook Ultrasound for surgeons: Part 2s based on evaluation prompted by clinical exam. They concluded that routine screening would not have benefited 95% of their high-risk population, andEbook Ultrasound for surgeons: Part 2
thus was nor warranted. The majority of venous thromboembolic disease in trauma patients is clinically silent, thus this group likely missed occult DChapter 7Surveillance of Deep Vein Thrombosis (DVT)Rajan Gupta and Jeffrey CarpenterIntroductionI he clinical evaluation ol the peripheral venous syst Ebook Ultrasound for surgeons: Part 2e ol the missed occult DVT population. Current recommendations by the ACCP Consensus Conference report suggest the development ol guidelines for the prevention ol thromboembolism lor each trauma center. In patients al high risk, consideration should be given to screening with duplex ultrasound.A stu Ebook Ultrasound for surgeons: Part 2dy performed recently ar rhe University of Pennsylvania examined rhe trauma center’s experience with clinical management guideline directed duplex surEbook Ultrasound for surgeons: Part 2
veillance for DVT in high-risk patients.’ Consecutive trauma patients were stratified into four different categories based upon presence of establisheGọi ngay
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