Case 03

Pt is a 43 year old female with a history of smoking and bipolar disorder who presents with left leg pain and swelling. She denies any fevers or chills, SOB, chest pain, cough, recent travel, surgery or injury.

PHYSICAL:

Vitals: T: 98,  P 67,  BP 127/80,  RR 16,  O2SAT 98

CONSTITUTIONAL: NAD. Patient appears WDWN. Patient is alert.
CARDIOVASCULAR: RRR, No MRG DP/PT/femoral pulses equal and symmetrical, cap refill b/l LE <3 seconds.
RESPIRATORY: Breath sounds clear, no distress present, no wheezing rales, rhonchi or tachypnea. Normal rate and effort.
GI/ABDOMEN: Soft, non-tender, no organomegly, no pulsatile mass. Normal bowel sounds.
MS: Tender to palpation in the left leg and groin.
INTEGUMENTARY: Color normal for age and race. Warm and dry to touch. +Left LE swelling.
NEURO: Motor/Sensory: No motor or sensory deficit.

LABS:

WBC 10.7
HG/HCT 14/43
Plt 279
BUN 10
CR .0.86
GFR 72
Normal electrolytes, LFT’s and lipase
PTT 28.5
PT 12.1
INR 1.0

A bedside ultrasound of the lower extremities was performed.

Right extremity as shown below: 

1. Is this normal or abnormal? 

2. What are the four anatomic locations to look for a lower extremity DVT?

3. What does this image depict?  What anatomic location are we viewing with the ultrasound?

4. What does the image below show?  What anatomic location are we viewing with the ultrasound?

5. What does the image below depict?  What anatomic location are we viewing with the ultrasound? 

6. What are the three branches of the popliteal vein?

7a. What are the four ultrasound findings indicative of DVT? 

7b. Which two findings are commonly used in the ED?