First 5 minutes and safety
›First 5 minutes and safety
›Monitoring and access
›Cardiac monitor when pulmonary embolism concern
›Pulse oximetry when dyspnea or chest symptoms
›IV access when unstable or high risk
›Immediate escalation
›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
›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
›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
›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