a) List the risk factors, clinical features and relevant investigations for occlusive upper limb deep venous thrombosis (ULDVT) in critically ill patients. (50% marks)
b) Discuss the available management options. (50% marks)
Risk factors: (20% Marks)
5-7 correct 1 mark
<5 correct 0.5 mark
Clinical Features: (20% Marks)
Investigations: (10% Marks)
Compression ultrasound is the diagnostic standard, with >95% sensitivity and specificity. (this detail not required)
Doppler and CT may be required to diagnosis intrathoracic/super vena cava (SVC) obstruction.
Treatment: (50% Marks)
Treatments aim to alleviate the symptoms, prevent thrombin propagation and pulmonary embolism, and prevent post-thrombotic syndromes.
(Highlighted points in treatment section are required for a pass mark.)
Topic was poorly understood, with little knowledge beyond superficial. It was suspected that that relates to poor exposure and experience of more advanced interventions (thrombolysis, possible radiology directed treatments). Little was mentioned around importance of lines in thrombosis and almost everyone who remembered wanted to pull the lines out without thought or consideration of the implications.
Risk factors for upper limb DVT from Kommareddy et al (2002):
Specific difference between upper limb and lower limb DVT risk factor profiles, according to Cote et al (2017):
Guidelines from the American College of Chest Physicians (Kearon et al, 2012) recommend the following anticoagulation regimen:
In addition to this (not instead of it), one may need acute intervention:
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