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Old 08-17-2013
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Cool compression usg vs heparin

45 y female with past history of RA come to ER with right calf pain and swelling of sudden fever no chills .history of smoking for 20 years...methotrexate for RA .vitals are normal.on physical examination, right calf is mild tender and no redness.
which of following next best step in managment?
b- compressinon-usg
c-start heparin
d-start warfarin
e blood culture and antibiotic

well this is uworld question..and i am confuse between heparin and usg...pls explain me ....
uworld says usg first and i think she is in emergency and sign symptom and physcial show DVt so why should we not start with heparin..??and i have one algorythm .it also says same thing that start with heparin first then do usg.
pls help me to get rid of this confusion.
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Old 08-17-2013
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uw clearly says decision to anticoagulate in DVT is based on non invasive tests ( not clinical) so usg first.
I dont know about this algo., follow uw

in case of PE -if high suspiscion clinically -> can start anticoagulant if no
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drmdshah (08-17-2013)
Old 08-18-2013
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In case of RA esp with normal vitals, differential diagnosis of calf pain is rupture of Baker's cyst...
remember that PE shud @ least cause some tachycardia & tachypnea
so u need to cofirm by USG
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Cardiology-, Internal-Medicine-, Step-2-Questions

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