Trauma Guideline Manual - SUNY Upstate Medical University

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128____________ Trauma Guidelines ManualSUNY Upstate Trauma CenterPRACTICE GUIDELINES: DEEP VENOUS THROMBOSIS PROPHYLAXISOBJECTIVES:1. Define the patient at risk for deep venous thrombosis (DVT) and will benefit from appropriateprophylaxis in the surgical setting2. Define guidelines for DVT prophylaxis that most appropriately reduce the incidence of DVTand pulmonary embolus3. Define diagnostic and treatment protocols for DVT4. Define surveillance protocols to detect occult DVTDEFINITIONS:Deep venous thrombosis (DVT) – spontaneous development of clot in the veins of the leg orpelvisPulmonary embolus – dislodged clot that has formed in the veins of the leg and/or pelvis thathas migrated to the right heart or pulmonary arterial circulationDVT prophylaxis – specific therapy that is used in high-risk patients to prevent the occurrence ofDVTPulmonary embolus prophylaxis – specific treatments to prevent the migration of blood clots intothe pulmonary vasculatureGUIDELINES: PATIENTS > 12 YEARS OF AGE1. Determination of DVT riska. Every patient admitted to the trauma service will undergo a DVT risk assessment byusing the “Risk Factor Assessment Tool” (in table below)b. SCD – Sequential compression device on all patients post-op or at bedrest with nocontraindications( i.e. External fixator, compartment syndrome, etc)c. Heparin prophylaxisi. Heparin 5,000 units SQ q12 hours ONLY for patients with renal failure.2. Moderate Risk – SCD and Lovenox 40mg SQ daily3. High Risk – SCD and Lovenox 30mg SQ BID4. Very High Risk – SCD and Lovenox 30mg SQ BID
Trauma Guideline Manual______________SUNY Upstate Trauma Center129Low Risk• Minor Surgery- < 40 yo without additionalrisk factorsModerate Risk• Major surgery (>60 min, abd or lowerextremities) >40 without additional riskfactors• Minor surgery - 40-60 yo withoutadditional risk factors• Immobilizing plaster cast or splintHigh Risk• Major surgery - > 40 yo without additionalrisk factors• Major surgery - < 40 with additional riskfactors• Minor surgery - > 60 yo with additionalrisk factors• Hip and knee replacement surgeryVery High Risk• Patients > 40 with any of the following:• Brain injury- Prior VTE- Cancer- Hypercoagulable state- Multiple risk factors• Multiple trauma- Fractured pelvis- Multiple lower extremity long boneinjuries- Spinal cord injury- Prolonged immobilization• Brain injuryAdditional Risk Factors• History of VTE• History of prior major surgery• Malignancy• Inflammatory bowel disease• Obesity• Oral contraception5. Indications for permanent vena cava filter – all of the following factorsa. Very high risk and cannot be anticoagulated, andb. Age > 45yr (consider lower age if retrievable filter placed), andc. One of the following injury patternsi. Spinal cord injury
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Trauma Guideline Manual - SUNY Upstate Medical University

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