Physician's Assistant

Patient Details

Sdec (281 days ago 14:20)

Sdec Sun 29 June 2025 14:20

Last Modified: 281 days ago

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Content:

Presenting Complaint:
Right calf pain and swelling

Past Medical History
• Hypertension
• No known drug allergies

Diagnosis:
Suspected right calf deep vein thrombosis

I had the pleasure of meeting Mr Richard Greenwood in Same Day Emergency Care today.

Mr Greenwood is a gentleman who presented with a 2-day history of right calf pain and swelling. He had been power washing his driveway on Friday, finishing around 14:00, and first noticed a red mark on his right calf that day. The symptoms have progressively worsened over the subsequent 48 hours with increasing pain and swelling. On examination, the right calf is visibly more swollen than the left, tender to palpation, and warm to touch. There is a prominent varicose vein present. He remains systemically well with no shortness of breath or constitutional symptoms.

His past medical history is significant for hypertension, for which he takes Losartan and Amlodipine. He also takes Fexofenadine for recurrent rashes. He has no history of bleeding disorders and remains active, walking his dog 2-3km daily.

Observations on arrival showed NEWS score 0: respiratory rate 18, oxygen saturations 97% on air, blood pressure 138/103mmHg, pulse 86bpm, temperature 36.7°C.

Investigations:
D-dimer: 0.9 (high)
Full blood count: Normal

Plan:
1. Commence therapeutic anticoagulation with high-dose Apixaban for suspected DVT
2. Urgent venous duplex ultrasound scan arranged for Tuesday 11:30
3. ECG performed
4. Follow-up appointment arranged post-scan to review results and ongoing management
5. Safety netting advice given regarding signs of pulmonary embolism

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Sdec Sun 29 June 2025 14:20

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