The Fellow on Call: The Heme/Onc Podcast Episode 131: VTE Series-Approach to workup and initial management
Mar 26, 2025
Dive into the world of venous thromboembolism (VTE) as experts unravel the essentials of diagnosis and initial management. Discover the importance of accurate imaging and the collaborative efforts among medical specialties. Learn strategies for managing pulmonary embolism and deep vein thrombosis, including advanced imaging techniques and the role of IVC filters. Unpack the complexities of anticoagulation management and the risks associated with thrombolytics. Engage with patient risk factors that shape treatment decisions!
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Diagnosing Pulmonary Embolism
- Use CT pulmonary angiography to confirm PE diagnosis unless contraindicated; bedside echo helps assess hemodynamic instability.
- Obtain baseline CBC, CMP, PT, and PTT before anticoagulation for safety and procedure planning.
Managing Hemodynamic Instability
- In hemodynamic instability from PE, prioritize stabilization with anticoagulation, pressors, and supportive care.
- Perform bedside echo for right heart failure; after stabilization, confirm diagnosis with CTA before advanced interventions.
Systematic DVT Evaluation
- For suspected DVT, assess limb perfusion to rule out ischemia and perform Doppler ultrasound to identify clot extent and site.
- Look for compressibility and blood flow patterns; chronic vs acute clot differentiation relies on clinical correlation and prior imaging.