DVT Exam
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Introduction

A swollen, tender, warm, red calf can be indicative of several conditions, one of which is Deep Vein Thrombosis (DVT).

Other differentials could include include cellulitis, muscle injury, achilles tendon rupture, phlegmasia and varicose eczema. Examining a swollen leg is a common OSCE station.

Introduction

  • Introduce yourself
  • Check you have the right patient
  • Explain what you are going to do
  • Gain consent
  • Wash hands! 

Inspection

  • Look around the bed for any mobility aids
  • Look for signs of pregnancy
  • Look for signs of any recent surgery or trauma
  • Look for GTN spray (atherosclerotic disease – increase risk factor)
  • Look for breathlessness – may be present if there is a secondary PE

Inspection of the legs

  • Look for any obvious redness and swelling
  • Look for varicose veins
  • Look for missing digits
  • Look for ulcers
Patient with phelgmasia DVT of the left leg
Patient with phelgmasia DVT of the left leg. Phlegmasia is a severe form of DVT with complete occlusion of the venous circulation, resulting in an acute onset presentation, and unlike a more traditional DVT it is associated with significant pain.

Palpation

  • Check the temperature of the legs at 3 different places. Compare the legs each time
  • Check pulses
  • Check for pitting oedema
  • Check for tenderness – squeeze the patient’s leg around the ankle. Tell them what you are going to do first! Ask them if there is any pain, and look at their face! Repeat with the other leg
  • Measure the diameter of the leg with a tape measure! Choose a point on the calf, and measure the same point on each leg. Usually this is 10cm below the tibial tuberosity.
  • If there is a difference between the legs of >3cm then this is significant for DVT

Auscultation

  • Listen at the lung bases – if PE is present, then there may be reduced breath sounds at the lung bases

Finishing off

Thank the patient, and tell them they can now cover up
Mention any further investigations:

  • Well’s score – if this is low, do a D-dimer
  • Bloods – U +E’s, clotting, FBC
  • Duplex scanning – USS + Doppler
  • Venogram

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

This Post Has 2 Comments

  1. Mukesh

    do you hav any printable version of your pages, please?

  2. tom

    Hi Mukesh, there should be a green button in the right hand sidebar labelled “PrintFriendly” under the heading “Page Tools”. Click there. Tom

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