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Decision
Point 4
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CONTINUED PATIENT COURSE
It is now 11:30pm. The hospital has the capability of performing Duplex
ultrasound studies for DVT, but only between the hours of 8am and 4pm.
Contrast venography can be performed during "off hours," but when the
test is described to the patient, she refuses to undergo it. She is receptive
to the idea of a Duplex study, and is willing to stay in the ED until
8am (if she is allowed to eat and have access to a "real bed" and a television),
but would prefer to return to her hotel and assures the physician that
she will return at 8am for the study if it can be scheduled for her as
an outpatient. Select an appropriate management option
a) Keep the patient in the ED overnight
and hold treatment and further diagnostic evaluation until 8am.
b) Start
an intravenous infusion of unfractionated heparin (UFH) and keep the patient
in the ED overnight until the duplex study can be performed.
c) Give
the patient a subcutaneous dose of low-molecular-weight heparin (LMWH)
and keep the patient in the ED overnight until the duplex study can be
performed.
d) Give
the patient a subcutaneous dose of LMWH and discharge her with instructions
to return at 8am for an outpatient duplex study.
e) Admit
and start intravenous LMWH.
f) Admit
and start subcutaneous LMWH.
g) Discharge
on subcutaneous LMWH with instructions to follow up with her primary care
provider when she returns home.
h) Discharge
on subcutaneous UFH with instructions to follow up with her primary care
provider when she returns home.
i) Discharge
on oral warfarin with instructions to follow up with her primary care
provider when she returns home.
This question has more than one answer that could be correct.
