CICM SAQ 2010.1 Q10
Question
A 30 year old man has been admitted to hospital with severe multiple injuries following a motor vehicle accident.
On day 2, his intracranial pressure has stabilised and his head CT shows scattered punctate haemorrhages with subarachnoid blood, with no mass lesion requiring evacuation. His pelvic fracture and right tibia / fibula fracture have been managed with external fixation and a left leg femoral fracture has undergone open reduction and internal fixation.
He has been in good health, but had a DVT 3 years ago and is not on any regular medication.
Outline your approach to prophylaxis for venous thrombo-embolism in this patient.
Answer
Answer and interpretation
Risk of VTE is high based on:
- Major trauma with pelvic and lower limb injury and operative intervention
- Possibility of a pro-thrombotic disorder
Therapy also has potential risks:
- Risk of intracranial haematoma expansion with unfractionated or LMW heparin
Management options:
- Quantify potential pro-thrombotic disorder: ancillary history, previous
- Investigations, etc
- Unilateral mechanical prophylaxis
- Discuss timing of pharmacological prophylaxis
- Clinical and imaging surveillance
- IVC filter
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Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
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