FacebookRssXInstagramSoundCloud
Generic filters
Exact matches only

About Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
FacebookX

PV card: Diagnosis of DVT (ACCP guidelines)

DVT

A patient presents with an asymmetric leg with trace pitting edema in the affected leg. What is your diagnostic approach to such a patient? What is the role of D-dimer and ultrasound (U/S)? Does this match the 2012 American College of Chest Physicians (ACCP) guidelines?

The first step is to determine your patient’s pretest probability because the recommendations vary based on risk. I can tell you that many ED patients come in with a Wells score of 1-2, which places them in the “moderate pretest probability” category. There are 2 approaches you can take based on the availability of resources at your site (high-sensitivity D-dimer or U/S) and the patient’s comorbidities. Are you referring your patient for a repeat outpatient ultrasound, if warranted?Walk through various patient scenarios to see how the D-Dimer and U/S come into play.

PV Card: Diagnosting DVT – ACCP Evidence Based Guidelines


Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Thanks to Dr. Jason West (EM resident at Jacobi/Montefiore) for this card idea and deciphering the complex recommendations from the publication.

Reference

  1. Bates S, Jaeschke R, Stevens S, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e351S-418S. [PubMed]
By |2021-10-08T09:29:18-07:00Jan 24, 2013|ALiEM Cards, Cardiovascular|
Read More

Trick of Trade: Incision and loop drainage using tourniquet

AbscessPacking

The technique for abscess drainage traditionally is incision and drainage (I&D). In August 2012, I wrote about incision and loop drainage (I&LD), which it seems has gained popularity over time with similar outcomes. This technique involves using a sterile vascular loop, which is thin and long enough to form a loose knotted loop. The video below by Dr. Rob Orman reviews the steps. But, what if you don’t have a vascular loop in the ED?

(more…)

By |2019-01-28T22:07:44-08:00Jan 22, 2013|Tricks of the Trade|
Read More

Patwari Academy videos: Low risk chest pain

One of the most common complaints in the Emergency Department is chest pain. Is it something serious? How do I risk-stratify patients with potential acute coronary syndrome? What should I be thinking of and not missing?

Rahul goes over the low-risk chest pain patient in 2 great, short teaching videos, based partly on the 2010 AHA/ACC Guideline for ACS risk stratification.

(more…)

By |2019-01-28T22:08:02-08:00Jan 20, 2013|Cardiovascular, Patwari Videos|
Read More

Trick of Trade: Rule of 10’s for burn fluid resuscitation

 

A patient presents with burns to both his arms, chest, and abdomen (anteriorly only) from a flash fire. That’s about 27% total body surface area (TBSA). So how much IV fluid should be given?

Be aware of a phenomenon known as “fluid creep”, where patients actually get WAY too much IV fluids than they should, which can cause delayed complications such as ACS, pulmonary edema, and compartment syndrome. Don’t forget that patients often get a lot of IV fluids in the prehospital setting, which should also be factored in.

(more…)

By |2026-06-16T16:02:12-07:00Jan 15, 2013|Trauma, Tricks of the Trade|
Read More
Go to Top