TLDR: Here is the link to listen to the video demonstrating how to check for a DVT: https://youtu.be/T6e0J4d3M70

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Let's talk about ultrasound to look for DVT. You've probably heard of several protocols: points, zones, continuous, etc. What I'm proposing is relatively simple: start high, go down until you lose the vein, then look at the popliteal area. Call them PRN zones.

Why would we look for TVPs?

• Because the patient is in ACR/very unstable and we do not know why or we suspect a massive PE and the post-test probabilities increase dramatically if we find a DVT.

• Because we have a patient with a submassive or massive pulmonary embolism and we want to assess the thromboembolic burden. Useful information for those who will follow the patient subsequently.

• Since we are in the evening or at night and we hope to reduce the post-test probability of DVT low enough that we feel comfortable not to ACO empirically ad official Doppler.

How to position the patient?

• Hip fracture position! That is, slight hip flexion and external rotation.

• For the popliteal assessment, I stay in the same position most of the time. If access is more difficult, I place the hip and knee flexed (the heel rests on the stretcher and the knee is in the air, so the popliteal is accessible).

How do you look for TVPs?

1. Identify the femoral vein (no matter how high).

   1. Reminder: the vein is medial to the artery (NAVY – YVAN).

2. Trace the femoral vein (called the common femoral vein (CFV) at this point) to find the junction with the saphenous vein . (The branch is MEDIAL to the vein and therefore on the opposite side to the artery.)

   1. Case1_Clip1 we see the bifurcation and the saphenous vein also thrombosed.

3. Once the VFC-Saphenous junction is found, it is necessary to go up 1-2 cm even more proximally.

4. Start compressing the VFC so that the 2 walls touch -> most important criterion for eliminating a DVT!!

   • Perform compression q 1-2cm until it is too deep to be visualized (often occurs at 2/3-3/4 of the thigh, at this location the vein is called the femoral vein).

5. Subsequently, visualize the vein in the popliteal region, perform compression and do the same 1-2 cm more distally and 1-2 cm more proximally to complete the “zone”.

**The goal is not to see the clot, but to assess the vein's compressibility. If the vein does not compress from wall to wall --> DVT is highly suspected.

I'm sure you're left with some questions after reading the protocol above. That's why we filmed a short video of exactly 2:30 minutes to illustrate everything. Thanks to Avo and Samuel for their help! Here's the link: https://youtu.be/T6e0J4d3M70

To view positive cases, simply watch the following videos.