Clinical Case Summary: Ms. Carter
Published:
Name: Ms. Carter
• Age: 55 years old
• Gender: Female
• Diagnosis: Deep Vein Thrombosis (DVT) in the left lower extremity
• Medical History: Obesity, Recent hip surgery, Hypertension, Smoking
• Current Medications:
• Enoxaparin 40 mg subcutaneously once daily (low-molecular-weight heparin, LMWH)
• Lisinopril 10 mg daily (for hypertension)
• Simvastatin 20 mg daily (for hyperlipidemia)
• Aspirin 81 mg daily (for cardiovascular protection)
Presenting Problem: Ms. Carter presents to the emergency department with swelling, pain, and redness in her left lower leg, which has been progressively worsening over the past 48 hours. She recently had hip replacement surgery and is currently on bed rest. The physical exam reveals signs of a DVT, including positive Homan's sign, swelling, and warmth in the affected leg. An ultrasound confirms the diagnosis of a left lower extremity DVT.
Vital Signs:
• Blood Pressure: 135/85 mmHg
• Heart Rate: 78 bpm
• Respiratory Rate: 16 breaths per minute
• Temperature: 98.6°F (37°C)
Physical Exam:
• Left Lower Leg: Swollen, erythematous, with warmth to touch
• Cardiovascular: No signs of heart failure
• Neurological: No signs of stroke or TIA
Animated Video Solution
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Step by Step Written Solution
Hello! Let's analyze this clinical case together. We have Ms. Carter, a 55-year-old female diagnosed with Deep Vein Thrombosis, or D V T, in her left lower extremity.
Patient Profile: Ms. Carter
First, let's look at her risk factors. The triad of Virchow describes the main causes of clot formation: stasis, hypercoagulability, and endothelial injury.
Virchow's Triad
- Venous Stasis
- Endothelial Injury
- Hypercoagulability
In Ms. Carter's case, several items from her history match this perfectly. Her obesity and recent hip surgery contribute to venous stasis, especially since she is on bed rest.
Now, let's examine her current symptoms and physical exam findings. She presents with worsening swelling, pain, and redness.
Physical Presentation
- Left leg swelling
- Erythematous (redness)
- Warmth to touch
- Positive Homan's Sign
Note the positive Homan's sign; while not always reliable, it involves calf pain upon dorsiflexion of the foot and is a classic finding for D V T.
Her diagnosis has already been confirmed via ultrasound. Let's look at her current medications and see how they relate to her condition.
| Medication | Indication |
|---|---|
| Enoxaparin 40 mg | LMWH Anticoagulant |
| Lisinopril 10 mg | Hypertension |
| Simvastatin 20 mg | Hyperlipidemia |
| Aspirin 81 mg | CV Protection |
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