Thought I'd share the story of a DVT patient who walked through the door this week. 28 yr old female presented with a bad sprained ankle 2 wks ago. Came in 3 days after the initial sprain for osteo treatment. Had been cleared of fracture with an x-ray. Fairly standard osteo treatment to increase movement and decrease swelling, then strapped for support.
Returned one week later complaining of throbbing constant calf pain; intermittent numbness and tingling in the toes aggravated by icing, and swelling in the ankle and calf. She had complained of no calf pain the previous week. On examination there was mild swelling, no visible redness or heat, but was very tender to the touch. Measurement showed calf was 1 cm bigger than the other side.
I referred her to her GP, who she was able to get in and see within 3 hours. However, there are a number of nurses at her work place and when they heard she had a suspected DVT, they insisted on driving her to the ER so that she was seen immediately.
The ultrasound came back positive for 2 clots in the calf. The Dr also checked the x-ray which was taken the week before and said that it was inconclusive in regards to fracture.
Currently the patient is at home for 4 days, with nurses visiting daily for blood thinning injections. She is expected to follow up with her GP once treatment with the nurses has finished. And no flying for 3 months.
When I referred her, I was by no means certain she had a DVT. It was more a precaution before continuing with manual therapy. Being still very early on in my years of clinical practice, I still err on the side of caution.
I'd be interested to hear what others have been taught in regards to referral of suspected DVT patients... whether GP or ER. And perhaps the referral of other serious conditions...
Belmont
02 4945 4245
Warners Bay
02 4954 4511
