›Immediate CT angiography if available and no delay to reperfusion
›If DVT suspected without limb threat
›Wells score based pathway selection
›Compression ultrasound timing target within same visit when possible
Therapeutics
›Treatment plan by likely diagnosis
›Suspected DVT without contraindication
›Anticoagulation start if imaging delayed and high probability local protocol dependent
›Apixaban oral 10 mg twice daily for 7 days then 5 mg twice daily if appropriate
›Suspected acute limb ischemia
›Start unfractionated heparin IV bolus and infusion local protocol dependent
›Keep limb at neutral position and warm
›Cellulitis without abscess
›Cephalexin oral 500 mg four times daily for 5 to 7 days typical adult dosing
›MRSA coverage based on local resistance and risk factors
Reassessment loop
›Reassessment loop
›Timing
›Recheck pain and neurovascular status every 30 to 60 minutes in high risk cases
›Repeat vitals after analgesia and fluids
›Escalation triggers
›Worsening pain out of proportion
›New sensory or motor deficit
17Disposition/dispo17
Level of care criteria
›Disposition decision framework
›ICU or resuscitation bay criteria
›Hypotension or shock physiology
›Rapidly progressive infection with systemic toxicity
›Inpatient admission criteria
›Acute limb ischemia
›Compartment syndrome concern
›Observation pathway criteria
›Suspected DVT awaiting definitive imaging
›Moderate cellulitis requiring IV antibiotics
Discharge criteria and follow up timing
›Discharge pathway
›Criteria
›No limb threat features
›Pain controlled with oral medications
›Follow up timing
›Confirmed DVT outpatient follow up within 3 to 7 days
›Cellulitis recheck within 24 to 48 hours if high risk
18Discharge Instructions/di18
Copy discharge instructions
›Patient instructions
›Summary
›You were seen for calf pain and swelling
›Your evaluation did not show an emergency cause today or is being treated as discussed
›Medications
›Take medications exactly as prescribed
›If on blood thinner avoid NSAIDs unless your clinician says it is safe
›Activity
›Walk as tolerated unless instructed otherwise
›Elevate the leg when resting
›Follow up
›Follow up with your clinician within the advised timeframe
›If an ultrasound was deferred return for the scheduled study
›Return to the ED now for
›New or worsening shortness of breath
›Chest pain or fainting
›Worsening leg pain with numbness or weakness
›Rapidly spreading redness or fever
19References/r7
Guidelines and validated tools
›Reference set
›American Society of Hematology guidelines for venous thromboembolism management 2020
›CHEST guideline and expert panel report on antithrombotic therapy for VTE disease 2021
›NICE guideline venous thromboembolic diseases diagnosis and management most recent update local protocol dependent
›AHA and ACC guideline for the management of patients with lower extremity peripheral artery disease 2016
›IDSA guideline for skin and soft tissue infections 2014 update local protocol dependent
›Source instructions
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.