Suspect PE? Look for DVT

Why bother? 

1. It is a quick bedside test that requires little training
2. If a proximal DVT is found in a patient suspected of having a PE, then it is very likely that the patient does indeed have a PE1. Therefore, a positive DVT scan can preclude the need for a CTPA, thereby reducing time to treatment, cost of stay, and radiation exposure
3. In patients with suspected PE, DVT ultrasound can help guide difficult decisions such as thrombolysis
4. It can also be used in cardiac arrest (although there is no data on this) to decide whether to give thrombolysis, as right heart strain can occur in cardiac arrest and not necessarily due to PE– read Jeff Pippin’s post (Dilated RV? Proceed with caution) on this for more information

Convinced? Ok – so how do we do it? 

There are lots of different protocols for DVT ultrasound. Let’s talk about how to do extended compression ultrasound. 

• Place your linear probe where you would feel a femoral pulse locate the venous saphenofemoral junction. Here you have the common femoral artery, common femoral vein, and saphenous vein creating the classic mickey mouse appearance. 

• Compress the vein with your probe. If both venous walls touch and the vein fully collapses, then this excludes a DVT at this point.