▶️I think, the best evidence is available for CUS with limited scope for Venography.
And no role of D-Dimer.
#FOAMed
Some thought about DVT prophylaxis in ICU.
Part of my presentation on the same topic.
Question 1: What is the incidence of DVT and PE in current era of widespread thrombo-prophylaxis?
#FOAMed
▶️I think, the best evidence is available for CUS with limited scope for Venography.
And no role of D-Dimer.
#FOAMed
#FOAMed
Yes.
1⃣Number needed to prophylax to prevent 1 DVT - 20
2⃣Number needed to prophylax to prevent 1 PE - 52
3⃣Overall no major bleeding. But bleeding risk need to be individualised.
#FOAMeYes.
1⃣LMWH decreases DVT. But no difference in Proximal DVT.
2⃣No difference in PE.
3⃣No difference in major bleeding.
4⃣Lower incidence of HIT in LMWH (PROTECT Trial).
5⃣Overall advantage LMWH.
1⃣Maximum evidence is for Dabigatran.
2⃣But unfortunately even on Dabigtran with adequate Anti-factor Xa level maintained both DVT and bleeding risk remains high.
#FOAMed
#FOAMed
Suggestions.
1⃣GCS 13-15. No bleed expansion at 48-H. Start.
2⃣GCS 13-15. Some expansion at 48-H. Start only after 72-H.
3⃣GCS 3-12. Not before 72 H. But before 7-days.
4⃣For DAI. No bleeding. Start after 72-H.
5⃣Consult Neurosurgery.
#FOAMed
1⃣Standard anticoagulation.
2⃣Limited role for Catheter Directed Thrombolysis.
More from Health
Let's talk honestly about "informed consent."
Someone with decades of training gives someone with none advice usually packed into 1-3 mins. Huge amount is based on trust. Huge potential for bias built in. But also there is no obligation to provide real alternative options.
I am classified as 'gifted' (obnoxious and ableist term). I mention because of what I am about to say. You all know that I was an ambulatory wheelchair user previously - could stand - but contractures have ended that. When I pleaded for physio, turned down. But did you know...
I recently was chatting with a doctor I know and explaining what happened and the day the physiatrist told me it was too late and nothing could be done. The doctor asked if I'd like one of her friends/colleagues to give second opinion. I said yes please! So...
She said can you send me MRI and other imaging they did to determine it wasn't possible to address your contractures.
Me: What?
Dr.: They did a MRI first before deciding right?
Me: No
Dr: What did they do??!
Me: Examined me for 2 minutes.
Dr: I am very angry rn. Can't talk.
My point is you don't even know if you are making "informed" decisions because the only source of information you have is the person who has already decided what they think you should do. And may I remind you of a word called 'compliance.'
Someone with decades of training gives someone with none advice usually packed into 1-3 mins. Huge amount is based on trust. Huge potential for bias built in. But also there is no obligation to provide real alternative options.
MAiD isn't eugenics. The task for the medical profession is to ensure informed consent. Failures on that front should result in enforcement of the law. But Bill C-7 is the result of the existing regime imposing unnecessary, unconstitutional harms by blocked access to MAiD.
— Emmett Macfarlane (@EmmMacfarlane) February 13, 2021
I am classified as 'gifted' (obnoxious and ableist term). I mention because of what I am about to say. You all know that I was an ambulatory wheelchair user previously - could stand - but contractures have ended that. When I pleaded for physio, turned down. But did you know...
I recently was chatting with a doctor I know and explaining what happened and the day the physiatrist told me it was too late and nothing could be done. The doctor asked if I'd like one of her friends/colleagues to give second opinion. I said yes please! So...
She said can you send me MRI and other imaging they did to determine it wasn't possible to address your contractures.
Me: What?
Dr.: They did a MRI first before deciding right?
Me: No
Dr: What did they do??!
Me: Examined me for 2 minutes.
Dr: I am very angry rn. Can't talk.
My point is you don't even know if you are making "informed" decisions because the only source of information you have is the person who has already decided what they think you should do. And may I remind you of a word called 'compliance.'
