Question
A patient develops a deep venous thrombosis (DVT) and requires heparin. Four days later, she becomes hypotensive, and a CT scan reveals a large retroperitoneal hematoma. What is the next step in management?
| A. |
Stop heparin and observe
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| B. |
Reverse heparin and place a Greenfield filter
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| C. |
Give fresh frozen plasma (FFP)
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| D. |
Surgery to remove the hematoma and the DVT
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Show Answer
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Correct Answer � A
Explanation
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Ans. A
Retroperitoneal hematomas can be life-threatening. If a patient with a deep venous thrombosis (DVT) has been found to have a retroperitoneal hematoma, the ideal treatment is the discontinuation of anticoagulation.
If the patient has received heparin, reversal with protamine can be attempted.
After blunt trauma, selected retroperitoneal hematomas in the lateral perirenal and pelvic areas should not be opened up for exploration.
Explore retroperitoneal hematomas in the midline, laterally, paraduodenal, and pericolic if you have obtained proximal vascular control.
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