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Old 09-24-2011
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Default dvt next step ??

A 72-year old female with diabetes, hypertension, and coronary artery disease status post a myocardial infarction is admitted to the
hospital after sustaining a fall. She is in excruciating pain and is found to have a right femoralneck fracture. She is taken to the
operating room for an open reduction and internal fixation.Her postoperative course is uneventful,with no weight-bearing but in-bed
physical therapy beginning on postop day 2. On day 3 she complains of pain in the hip that is worse than previously, extending to the
ankle. Her physical exam is significant for an unremarkable incision site but increased distal edema and marked calf tenderness.
What is the next step in the management of this patient?
0 A.Administration of furosemide intravenously
0 B.Duplex venous now study
0 C.Initiation of low molecular-weight heparin therapy
0 D.Initiation of warfarin therapy
0 E.Venogram
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Old 09-24-2011
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B duplex venous now
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Old 09-25-2011
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B.Duplex venous now
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Old 09-25-2011
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C: Initiation of low molecular-weight heparin therapy.
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Old 09-25-2011
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B. Duplex venous study and, if a DVT is confirmed, then start on LMWH.
She should already be on LMWH prophylaxis.
D-dimer is not valid in this setting as it is in the postOP period (false positive rate for DD in this setting is high).
Also, bleeding risk increased due to recent surgery, so I'd say confirm diagnosis and treat.
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