[NP-Clinical] Re: DVT's
ckjordan373 at aol.com
ckjordan373 at aol.com
Wed Aug 1 20:58:46 PDT 2007
Yes, I am in a tourist destination but these cases are all my regular patients...no recent travels...nothing new...the only one who had something different was one that had incurred a twisting knee injury a few days prior...Pretty bizarre and somewhat scary.
Cyndy
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Subject: NP-Clinical Digest, Vol 17, Issue 2
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Today's Topics:
1. Re: update on Kim's Opto husband -
(Patricia.Thompson at hattiesburgclinic.com)
2. Re: update on Kim's Opto husband - (Lynda Woiblett)
3. RE: Re: DVT's (Lynda Woiblett)
4. RE: Re: DVT's - Email found in subject
(Patricia.Thompson at hattiesburgclinic.com)
5. RE: Re: DVT's - Email found in subject (Lynda Woiblett)
----------------------------------------------------------------------
Message: 1
Date: Wed, 1 Aug 2007 09:01:14 -0500
From: <Patricia.Thompson at hattiesburgclinic.com>
Subject: Re: [NP-Clinical] update on Kim's Opto husband -
To: <np-clinical at nurse.net>
Message-ID:
<7AB1FB693292A64C9A1506DBE75AD75202E23ECC at exchng01.hattiesburgclinic.com>
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Thank you so much for taking the time to give me this information. Great
learning experience. My goal is to be a hospitalist NP and this is showing me
what to do and what not to do.
Patricia T CFNP
-----Original Message-----
From: np-clinical-bounces at nurse.net
[mailto:np-clinical-bounces at nurse.net]On Behalf Of Kimberly Spering
Sent: Tuesday, July 31, 2007 10:07 PM
To: NP Clinical
Subject: [SPAMMSG] - Re: [NP-Clinical] update on Kim's Opto husband - -
Bayesian Filter detected spam
Thanks again to everyone for the well wishes. You cannot imagine how
uplifting it is to read the messages.
To answer your questions, Patricia, Mark had a CT of the abdomen w/ contrast
during last week's hospital stay, as the ER doc was looking at a GI cause
for the RUQ abd. pain. The pulmonologist on the second day ordered a CT of
the chest w/ PE protocol (I think it was a spiral CT)--which showed possible
PE vs. artifact. (Of course, these results were verbal; I have yet to see
results myself.)
With his first admission, I asked for a thrombophilia panel and D-dimer
before the pneumonia was diagnosed and before the blood thinner was given.
All that was ordered, apparently, was a PT/PTT/INR. The intensivist told me
that a D-dimer "would be positive anyway, so there isn't any point." Now,
whether she had already seen something on CT scan indicating inflammation,
or basing it on his 102.5 temp, I don't know. Nevertheless, a thrombo panel
was NOT ordered in NJ. I agree with Diane that you order a D-dimer to guide
your plan of testing/care, but you order it under the right
conditions/scenario. He did not have a VQ scan; the radiologist felt that
with his infiltrates, one would not get an accurate diagnosis of a PE.
The covering internist at our local hospital told me that with Mark's
presenting s/s and last week's episodes, he is being treated for a PE NOW,
irregardless of any prior test results. He felt strongly that a negative
doppler last week meant nothing--he may have already thrown a clot, and that
Mark's having the CT of the chest AFTER the Arixtra may have shown a false
negative result for PE, anyway. Plus, then he laid in a hospital bed for
three days until he could breathe well enough to get OOB.
SO...now he is on a treatment dose of Lovenox (weight-based) BID; they
started Coumadin this evening, and the plan is to discharge him home
tomorrow. He will have 5 days of Lovenox while titrating Coumadin, then
maintenance on Coumadin for several months. They DID draw a modified
thrombophilia panel HERE before starting the Lovenox--1 week post Arixtra.
If the anti-thrombin III or Factor V Leiden are positive, then they will
most likely give 6 months of Coumadin, recheck the panel after off the med,
and see where things stand. If the tests are negative, probably they will
look at a 3-month period of Coumadin.
>From my research, confirmed by the docs today, unless there is a
larger-vessel, above-the-knee clot, there isn't as much chance of a PE, and
a Greenfield filter won't be needed. Now, he does have popliteal
involvement, so we aren't totally out of the woods for PE yet, but it's
unlikely as he gets more Lovenox. He sat out in a chair briefly, but had
much more leg pain while dangling. Officially, he is on bedrest till
tomorrow, then ADLs as tolerated. He won't go back to work until Saturday
(half day), which is driving him nuts, but I think he's willing to do
anything to NOT be re-admitted.
I was also very happy to find that one of the group's physician assistant
was phenomenal. She graduated from DeSales University, which to my
knowledge still has the # 1 program in the country (and my FNP alma mater).
The only bugger was that she isn't allowed to order Coumadin or Lovenox at
the pharmacy...which I heard will be changed eventually, but it delayed the
scripts a bit while waiting for the doc to write them. She was an
outstanding representation of what PAs do.
I'm resting easier tonight, for sure. What a difference in care and
explanations of what's going on.
Kim
----- Original Message -----
From: <Patricia.Thompson at hattiesburgclinic.com>
To: <np-clinical at nurse.net>
Sent: Tuesday, July 31, 2007 11:26 AM
Subject: [NP-Clinical] update on Kim's Opto husband -
> Kim,
> GOD speed in the recovery of your husband. But a few questions, have they
> done a CT with PE protocol to find out if he has a PE or are they taking
> it at face valve that he has one because of the DVT, pain and SOB. Yes,
> DVT can grow that fast with being non active in the hospital the first
> time and not knowing what was really going on. Did I read they checked
> his clotting and bleeding factors at the other hospital? Is he getting
> Lovenox BID or pharmacokinetics. What is his activity? Are they going to
> place a IVC filter to prevent other clots from migrating up the channels
> to the lung? Just curious how other facilities medically manage there
> patients.
> Stay Encouraged an Uplifted,
>
> Patricia T CFNP
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Message: 2
Date: Wed, 01 Aug 2007 11:34:30 -0400
From: "Lynda Woiblett" <lwoiblett at msn.com>
Subject: Re: [NP-Clinical] update on Kim's Opto husband -
To: np-clinical at nurse.net
Message-ID: <BAY111-F1928B2D52EB7B9F0730097B3E80 at phx.gbl>
Content-Type: text/plain; format=flowed
Patricia,
I was a hospitalist NP for 5 years...best fun I ever had! Best wishes to
yuo as you head for this!
LynnW
My goal is to be a hospitalist NP and this is showing me what to do and
what not to do.
>Patricia T CFNP
------------------------------
Message: 3
Date: Wed, 01 Aug 2007 11:36:40 -0400
From: "Lynda Woiblett" <lwoiblett at msn.com>
Subject: RE: [NP-Clinical] Re: DVT's
To: np-clinical at nurse.net
Message-ID: <BAY111-F329A47A34191F709BD1490B3E80 at phx.gbl>
Content-Type: text/plain; format=flowed
Cyndy,
I am in a tourist destination and we alsways saw an increase over the high
travel months...car/plane/bus/train sitting!
Could this be true for where you are?
Lynn W
>It is rather mind boggling when I think of the recent surge of DVT's I have
>been seeing...3 last week alone and in the past couple months about 8.
>Wonder why? I realize that our society has become rather sedentary but this
>is amazing.
>
>Cyndy Jordan NP
>Colorado
>
------------------------------
Message: 4
Date: Wed, 1 Aug 2007 11:05:15 -0500
From: <Patricia.Thompson at hattiesburgclinic.com>
Subject: RE: [NP-Clinical] Re: DVT's - Email found in subject
To: <np-clinical at nurse.net>
Message-ID:
<7AB1FB693292A64C9A1506DBE75AD75202E23ECF at exchng01.hattiesburgclinic.com>
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Can it be high altitude with car/plane/train/bus sitting?
Patricia T
-----Original Message-----
From: np-clinical-bounces at nurse.net
[mailto:np-clinical-bounces at nurse.net]On Behalf Of Lynda Woiblett
Sent: Wednesday, August 01, 2007 10:37 AM
To: np-clinical at nurse.net
Subject: [SPAMMSG] - RE: [NP-Clinical] Re: DVT's - Email found in
subject
Cyndy,
I am in a tourist destination and we alsways saw an increase over the high
travel months...car/plane/bus/train sitting!
Could this be true for where you are?
Lynn W
>It is rather mind boggling when I think of the recent surge of DVT's I have
>been seeing...3 last week alone and in the past couple months about 8.
>Wonder why? I realize that our society has become rather sedentary but this
>is amazing.
>
>Cyndy Jordan NP
>Colorado
>
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------------------------------
Message: 5
Date: Wed, 01 Aug 2007 12:29:10 -0400
From: "Lynda Woiblett" <lwoiblett at msn.com>
Subject: RE: [NP-Clinical] Re: DVT's - Email found in subject
To: np-clinical at nurse.net
Message-ID: <BAY111-F8CCF22E8C50DE0855EF66B3E80 at phx.gbl>
Content-Type: text/plain; format=flowed
I think it is more the long time sitting rather than the altitude
Lynn
>From: <Patricia.Thompson at hattiesburgclinic.com>
>Reply-To: NP Clinical <np-clinical at nurse.net>
>To: <np-clinical at nurse.net>
>Subject: RE: [NP-Clinical] Re: DVT's - Email found in subject
>Date: Wed, 1 Aug 2007 11:05:15 -0500
>
>Can it be high altitude with car/plane/train/bus sitting?
>Patricia T
>
>-----Original Message-----
>From: np-clinical-bounces at nurse.net
>[mailto:np-clinical-bounces at nurse.net]On Behalf Of Lynda Woiblett
>Sent: Wednesday, August 01, 2007 10:37 AM
>To: np-clinical at nurse.net
>Subject: [SPAMMSG] - RE: [NP-Clinical] Re: DVT's - Email found in
>subject
>
>
>Cyndy,
>I am in a tourist destination and we alsways saw an increase over the high
>travel months...car/plane/bus/train sitting!
>Could this be true for where you are?
>Lynn W
>
>
>
> >It is rather mind boggling when I think of the recent surge of DVT's I
>have
> >been seeing...3 last week alone and in the past couple months about 8.
> >Wonder why? I realize that our society has become rather sedentary but
>this
> >is amazing.
> >
> >Cyndy Jordan NP
> >Colorado
> >
>
>
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>NP-Clinical mailing list
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>
>
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>
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