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Leg Pain, LMWH for future long flights/hospitalization - Coggle Diagram

- - - - No radiating pain, numbness, or back involvement
    - - Unilateral symptoms, no diabetes or neuropathic signs (tingling/numbness)
  - - - Acute onset (4 days), no mass/night pain, no constitutional symptoms
  - - - Eliminated
        
        No systemic symptoms (fever, rash), unilateral presentation
    - - Eliminated
        
        Progressive not acute,
    - - Pathophysiology
        
        Virchow's Triad (1. Stasis [Obese & Immobility] 2. Endothelial Injury [Smoking & Obese] 3. Hypercoagulability -> Increase Coag factors])
        
        Thrombus in Deep Vein (DVT)
        
        Thrombus Accumulation
        
        Constant Thrombus (Fibrin) Breakdown
        
        Elevation of D-Dimer
        
        Platelet activation & aggregation
        
        1 more item...
        
        Vein Obstruction
        
        Impaired Venous Return
        
        1 more item...
        
        Inflammation
        
        1 more item...
      - Risk Factors
        
        Non-Modifiable
        
        male sex
        
        Modifiable
        
        Smoking
        
        Sedentary lifestyle
        
        Acquired
        
        Prolonged sitting
      - Prevention and Education
        
        Smoking cessation
        
        Ambulation breaks every 1–2 hours
        
        Recognize PE symptoms (chest pain, dyspnea).
        
        Compliance with anticoagulants (avoid NSAIDs/alcohol).
      - Treatment & Management
        
        Avoid warfarin (requires INR monitoring; less ideal for acute phase).
        
        REFER
        
        LMWH (e.g., enoxaparin 1 mg/kg BID) + transition to DOAC (rivaroxaban/apixaban)
        
        Supportive care
        
        Leg elevation and hydration.
        
        Compression stockings (20–30 mmHg) to reduce swelling/PTS risk.
      - Prognosis and Complications
        
        Prognosis
        
        Good with early treatment
        
        recurrence risk 25% at 5–10 years
        
        Complications
        
        PE (12% mortality if untreated)
        
        Post-thrombotic syndrome (PTS; 30–43% risk) (chronic pain/ulcers)
  - - - No fever, leukocytosis (15.1 × 10³/µL) could be reactive but no source of infection
    - - No fever, bone pain, or history of infection
  - - - Eliminated
        
        No history of trauma, pain worsens with activity (strains improve with rest)
    - - Eliminated
        
        No trauma, bruising, or deformity
  - - - Patient not on statins
    - - No neuropathic symptoms (numbness/tingling)
- - - - Swelling and redness in the left leg
      - Pain worsens with walking/standing, improves with rest/elevation
      - Sudden onset of left leg pain (intermittent but worsening over 4 days)
    - - secretary (prolonged sitting)
      - smoker (12 years, 1 pack/day)
    - - No trauma or prior episodes
  - - - Vitals
        
        Tachycardia (HR 110 bpm)
        
        BP 130/80 mmHg
      - Left Leg
        
        Vein distension (visible collateral veins)
        
        Tenderness on palpation along deep veins
        
        Homan’s sign (+): Pain on dorsiflexion
        
        Hyperemic, warm, edematous
      - Extremities
        
        Limited mobility due to pain; prefers lying down.
      - Wells score +4
        
        Swelling on entire left leg +1
        
        Localized Pain along deep vein when pressed +1
        
        Pitting edema
        
        Lie down >3 days recently +1
    - - D-dimer
        
        7899 ng/mL (markedly elevated; normal <500 ng/mL)
      - CBC
        
        Leukocytosis (15.1 × 10³/µL): Suggests inflammation/infection.
        
        Thrombocytopenia (103k/µL): May indicate consumptive process (e.g., DVT).