Question

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Patient A.B. is a 70-year-old male who had a right total knee replacement done yesterday. His past medical history includes osteoarthritis, hypertension, high cholesterol, diabetes mellitus, and GERD. During your initial shift assessment, the patient is noted to have swelling in his right calf and reports tenderness to touch in the calf region. You ask him to dorsi/plantar flex his right foot against resistance from your hand, and he indicates that the pain in his calf worsens with flexion. You suspect the patient has a DVT.

1. What other signs and symptoms might you expect to find in this focused assessment?

2. Based on the results of your assessment, what do you do? What type of further follow-up might be needed?

Answer 1

1.Based on the examination this patient is suspected to have DVT. Signs and Symptoms that we expect :

Signs:Homans sign: Resistance of calf muscles to forcible dorsiflexion.

Moses sign: Calf tenderness on direct pressure on the calf.

Pratt's sign: calf tenderness on squeezing the calf from the sides.

Perthes test : Elastocrepe bandage applied and allowed to walk. DVT cases will have severe pain on walking.

Symptoms: Pain and swelling in calf, Increased temperature at local site, low grade fever.

2.Based on the assesment we will do :Modified wells criteria for predicting DVT -Based on the score :

Score : -2 to 0 low probability

1 to 2 moderate probability

More than 2, high probability.

And then for diagnosing this we have to do investigations like:

a. D dimer measurement: if normal no need for further investigations. If raised a duplex ultrasound of deep veins should be performed.

b. Duplex ultrasound.

Pulmonary embolism is the most dangerous complication of the DVT and primary objective of the treatment is to prevent development of pulmobary embolosm.

3.Follow up in this patient will be as follows:

After initial diagnosis, Low molecular weight Heparin is started.

Moniter patient for development of severe pain in leg, cough, breathlessness.

Limbs were monitered by duplex ultrasound at intervals of 2 -3 days, 1-3 months, 6-8 months from initial time of diagnosis.