Venousthromboembolism is the formation of a blood clot in a deep vein of the body. Itis often leads to major complications such as Pulmonary embolism(PE), deep veinthrombosis(DVT) and post thrombotic syndrome.
It is very common to find outthis type of disorder with increased age with multiple co morbidities. Patientswho suffers cardiac complication majorly gets affected by the DVT and otherproblems. This is very complicated and risky condition in which there may bechance of death if not identified or controlled correctly. Working in aIn- patient rehab facility, it is always a challenging for me being a therapistabout how to start doing an evaluation and treatment protocol. Most of thepatients are going through with major trauma which includes accidents, trauma,cardiac complications, strokes and many other severe problems. As far as I amaware, all the patients have been treated by the nursing staff by blood thinnerto prevent the clot. However, the issue comes up when as a therapist we have tostart an evaluation by reading an order.
It is not always accessible andreadily available about patient’s information that what was his past record indetail. At that point, I used to get clearance from the nurse that if the patientis clear for evaluation regardless any problems. After completing anevaluation, screening process, sometime patient has been found out to reportthat he is having some discomfort in leg and feels like red and warm at times.Therapist can get an idea about possible issues but have to wait for doctor’sorder for ultrasound and possibly hold therapy.
Sometimes, I used to treatpatient in bed side avoiding a limb which is at risk for DVT. However, I wouldlike to prefer to communicate with doctor and hold therapy for few hours tillresults come out. After readingan article, I found out some important information about how to treat patientwith possible disorder of coagulation. It is always a very important to find outa past history of patient if he has any related problems with coagulation ortaking any blood related medication. It may predict some possibility forrecurrence if patient is at risk.
So,detailed history is very important. Another main important use is Mechanicalcompression. I would like to put this as a protocol for my future patients touse at night time from first day of rehab stay if they are not having any riskrelated to ABI (ankle-brachial index). Also, constant communication withmedical staff is very important if therapy should continue or should put onhold.
Sometime miscommunication can cause a big concern for life of a person astherapist may not aware about the hold and therapist scheduled a patient fortherapy. I would also implement a practice to check a medicine report as soonas I get my patients list about what medication they are taking and what timethey are scheduled for. By doing it so, even if not able to reach medicalstaff, one can be confident about safety issue of patient. ReferenceEllen, H., Michael, P., Ethel, M.
F., Mary, T., Dennis,C, S., & Beth, A. (2016) Role of the physical therapist in the managementof individual at risk for or diagnosed with venous thromboembolism: evidencebased clinical practice guideline. Streiff, M.B.
, Brady, J.P., & Grant, A.M.
(2014).Grand rounds: preventing hospital associated venous thromboembolism. Morb Mortal Wkly Rep, 63,190-193.