Questions to ask if you suspect DVT
Here are assessment tips to use at triage if you suspect that your patient might have deep venous thrombosis (DVT):
• If the patient complains of lower leg or calf pain, do a further assessment of the extremity. "The calf is touched for temperature and firmness, and observed for redness," says Curran Krupar, RN, ED nurse at EMH Medical Center in Elyria, OH.
• Ask the patients to pull their toes toward their head.
"We are looking for pain in the calf when this is performed. This is called a Homan's sign," says Krupar.
• If a patient presents with a calf that is swollen, hot to the touch, and painful, especially when bringing their toes toward their head, and complains of being short of breath, be concerned that a piece of the clot may have broken off and traveled to the lungs. "This is considered a life-threatening condition," says Krupar.
At Baylor Medical Center of Irving (TX), ED nurses frequently work up anyone who presents with any one or more of the following symptoms, says Lois Nicholas, RN, ED nurse:
— extremity swelling of unknown cause;
— extremity pain of unknown cause;
— extremity redness.
These questions are asked at triage:
— Is there any history of medical illnesses such as peripheral vascular disease?
— Have you had recent long-distance travel?
— Have you increased your exercise level recently?
— Do you have any cardiac history?
— Have you recently had a cast removed?
— Have you recently had surgery?
• If DVT is suspected, a simple blood test is run to determine the possibility of a clot being present somewhere. "If the D-Dimer comes back positive, an ultrasound is done of the extremity, and if a pulmonary embolism is suspected, a CT scan of the chest is done," says Nicholas.
• Ask about birth control pills specifically.
Krupar says to ask "Do you use birth control pills or have you taken them in the last month? If you have used birth control pills previously, when did you stop taking them?"