›If hypotension or hypoxia, pulmonary embolism pathway
›If cold pulseless limb, vascular surgery emergent
›If compartment syndrome concern, orthopedic surgery emergent
›Analgesia
›Acetaminophen PO 1000 mg
›Ibuprofen PO 400 mg
›Avoid NSAIDs if high bleeding risk
Diagnostic sequencing
›Diagnostic sequencing
›Deep vein thrombosis pathway
›Wells score category
›D dimer when low or intermediate probability
›Venous duplex ultrasound
›Cellulitis pathway
›Soft tissue ultrasound when abscess concern
›CBC and inflammatory markers when systemic features
›Limb threat pathway
›Immediate vascular imaging consideration
›Early surgical consultation
Therapeutics
›Therapeutics
›Anticoagulation for confirmed deep vein thrombosis
›Apixaban PO 10 mg twice daily for 7 days
›Apixaban PO 5 mg twice daily after day 7
›Rivaroxaban PO 15 mg twice daily for 21 days
›Rivaroxaban PO 20 mg once daily after day 21
›Low molecular weight heparin when pregnancy
›Avoid anticoagulation if active major bleeding
›Cellulitis antibiotics local protocol dependent
›Cephalexin PO 500 mg four times daily
›If MRSA risk, doxycycline PO 100 mg twice daily
›If severe systemic features, IV antibiotics pathway
›Superficial thrombophlebitis symptom control
›Compression and elevation
›NSAID use if low bleeding risk
›Anticoagulation consideration when extensive or near deep system
›Hematoma management
›Anticoagulant reversal decision based on severity
›Compartment syndrome monitoring
Reassessment loop
›Reassessment loop
›Recheck timing
›Every 30 to 60 minutes when severe pain
›After analgesia effect window
›Recheck targets
›Pain trajectory
›Neurovascular status
›Swelling progression
›Triggered escalation
›Worsening pain out of proportion
›New sensory deficit
›New hypoxia or dyspnea
17Disposition/dispo27
Admission and higher level care
›Admission and higher level care
›ICU criteria
›Hemodynamic instability
›High risk pulmonary embolism features
›Inpatient criteria for cellulitis
›Rapid progression
›Systemic toxicity
›Immunocompromise
›Inpatient criteria for deep vein thrombosis
›Extensive iliofemoral clot
›Phlegmasia concern
›High bleeding risk requiring monitoring
›Surgical admission criteria
›Compartment syndrome concern
›Necrotizing infection concern
Observation and discharge
›Observation and discharge
›Observation pathway
›Pending ultrasound with moderate risk features
›Early cellulitis with borderline systemic signs
›Discharge criteria
›Stable vital signs
›No limb threat features
›Reliable follow up
›Follow up timing
›Within 24 to 72 hours for cellulitis reassessment
›Within 7 days for anticoagulation follow up
›Earlier if symptoms worsen
18Discharge Instructions/di27
Copy discharge instructions
›Copy discharge instructions
›Today you were seen for swelling in one leg
›The main dangerous cause is a blood clot in the deep veins
›Other causes include infection of the skin and soft tissues or a muscle injury
›If you were diagnosed with a blood clot
›Take your blood thinner exactly as prescribed
›Do not miss doses
›Seek care immediately for bleeding that will not stop
›If you were treated for a skin infection
›Take antibiotics exactly as prescribed
›Mark the edge of redness and return if it spreads quickly
›Activity and limb care
›Elevate the leg when resting
›Use compression only if advised and if no arterial circulation problem
›Return to the emergency department now for
›New shortness of breath
›Chest pain
›Coughing blood
›Fainting
›Severe worsening leg pain
›Numbness or weakness
›Cold or blue foot
›Fever with rapidly spreading redness
›Follow up
›Arrange follow up within 2 to 3 days if infection suspected
›Arrange follow up within 1 week if on blood thinner
›Return sooner if symptoms worsen
19References/r7
Guidelines and decision tools
›Guidelines and decision tools
›American College of Chest Physicians antithrombotic therapy for venous thromboembolism disease guideline 2021
›National Institute for Health and Care Excellence venous thromboembolic diseases guideline NG158 2020
›American Society of Hematology guidelines for management of venous thromboembolism 2020
›Infectious Diseases Society of America skin and soft tissue infections guideline 2014
›Wells clinical prediction rule for deep vein thrombosis original validation 1997
›Project instructions source
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.