Obtunded neurological patients are at risk of development of deep venous thrombosis (DVT). Unless contraindicated, all patients should be maintained on subcutaneous heparin or low-molecular-weight heparin in addition to compressor stockings. Contraindications include active intracerebral hemorrhage and impending surgery. Post-operatively, it is safe to restart subcutaneous heparin after 48 hours. Doppler ultrasound to rule out DVT in the lower extremities should be performed when indicated.
Pulmonary embolism occurs not infrequently in these patients, and any sudden deterioration in gas exchange or systemic hemodynamics should prompt investigations. Spiral pulmonary CT is a good diagnostic test and, when confirmed, systemic heparinization is indicated. Where this is contraindicated because of intrac-
erebral hemorrhage, placement of a filter in the inferior vena cava is appropriate.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.