Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Deep vein thrombosis, Oedema peripheral, Peripheral swelling, Thrombophlebitis superficial
Clinical narrative: 51-year-old female presents to ED with left lower extremity edema.  Patient reports left lower extremity swelling, particularly in the calf and ankle couple weeks ago.  She denies any specific traumas or injuries, states she initially thought maybe she had sprained her ankle but is noted that the swelling had not improved.  Says theres some slight pain but moreso the swelling that was concerning to her. Has not noticed any erythema or ecchymosis.  No numbness, tingling, paresthesias.  No fevers or chills.  No chest pain or shortness of breath.  She is currently on estrogen oral contraceptive, no recent travel, immobilization, medical procedure, surgery, or trauma, hemoptysis, malignancy, coagulation disorders, history of DVT or PE.  States initially followed up outpatient and had an ultrasound that was done and she was instructed to come to ED for positive result.  No further symptoms or complaints at this time.  The patient's symptoms, exam, workup, and disposition were discussed with ED attending Doctor, proceeded with management accordingly. Physical exam as above. Patient afebrile, hemodynamically stable, well-appearing.  Chart review from earlier today shows ultrasound positive study for subacute nonocclusive proximal DVT in the left popliteal vein, and subacute superficial thrombophlebitis in the left lesser saphenous vein. No evidence of cellulitis or infection at this time there's no warmth or erythema or streaking. No bilateral edema, JVD, or evidence of fluid overload. Suspect patient's symptoms of left lower extremity swelling and pain likely secondary to the DVT and thrombophlebitis. No bony TTP or injuries no indication for bony imaging. No cp, sob, tachycardia, hypoxia.  Do not suspect PE. She does have a leukocytosis no urinary or respiratory symptoms lower suspicion UTI or pneumonia. No neck stiffness or pain to suggest meningitis. Area doesn't appear cellulitic at this time but could possibly be due to early cellulitis and the superficial thrombophlebitis. She's afebrile non septic appearing and will be started on abx nonetheless and she is given strict return precautions regarding this.  She has no contraindications to anticoagulation including no thrombocytopenia, active hemorrhage, history intracerebral hemorrhage, chronic anticoagulation. No findings suggestive of phlegmasia cerulea dolens. Labs including kidney function, liver enzymes discussed with ED pharmacist matt nagar. Patient has no significant commodities and is an appropriate candidate for outpatient DVT treatment with eliquis. She is educated regarding eliquis by ED pharmacist.  Discussed with patient the need to contact her doctor tomorrow regarding the oral contraceptives that she is currently taking, as there may likely need to be a change and/or discontinuation of this secondary to patient's DVT and starting on Eliquis.  She is instructed not to make any changes to medication regimen until she contacted her PCP, and again reiterated that she needs to speak with them first thing tomorrow morning regarding her birth control.  Patient expresses understanding. Given overall presentation and ED workup, believe patient is stable for discharge home at this time. Discussed at length strict written and verbal ED return precautions with patient. Patient will follow up with PCP, will start on eliquis and clinda. Patient expressed understanding and agreeable to this plan for discharge and follow up.