08.25 - Venous Thromboembolism (Muthiah) - Questions Flashcards
S1Q3T3
Right Ventricular Strain - Pathognomonic for PE
2 classic tumors that grow into venous system
Renal Cell Carcinoma, Lung Primary
3 important congenital hypercoagulabilities that predispose to PE
Factor V Leiden, Prothrombin Mutation, Proteins C and S deficiency
Most common cause of thrombocytopenia in the ICU
DIC
Commonest cause of DIC
Sepsis
What is our concern in Heparin Induced Thrombocytopenia
Even though platelet count low, can still clot
2 Actions of Warfarin
Blocks vit-K-dependent factors; Decreases production of Proteins C and S
2 important acquired hypercoagulabilities
HIT, Nephrotic
Pulmonary Vascular resistance after PE
Increased - serotonin, endothelin
Gas Exchange after PE
Increased dead space (v/q mismatch), low DLCO, shunting in massive PE
PaCO2 after PE
Hypocapnea, trying to maintain oxygenation, and CO2 diffuses more readily than O2
Alveolar ventilation after PE
Alveolar Hyperventilation - reflex stimulation of irritant receptors
Airway resistance after PE
Increased - Bronchoconstriction - Serotonin
Pumonary Compliance after PE
Decreased - Edema, Hemorrhage, Loss of Surfactant
Circulatory Compensation after PE
Vasodilation of uninvolved vasculature helps decr the incr in PVR, also improves V/Q relationship
Gas Exchange abnormalities after PE
Hypocapnia, Hypoxemia, Wide A-a
Blood pressure after PE
Pulmonary HTN, Systemic Hypotension
When might patients get bradycardia after PE
Beta Blocker
What causes BNP release
Ventricular Stretch (higher BNP associated with adverse outcomes)
Commonest arrhythmias after PE
A Fib, A Flutter
Sign of RV strain
S1Q3T3
Most common complaint from patient with acute PE
SOB
2 most common complaints after PE other than Dyspnea, Tachypnea, and Tachycardia
Pleuritic Pain, Loud P2
Heparin Antidote
Protamine Sulfate
A-a gradient after PE
Usually wide, but normal does not rule out
Widened Mediastinum on CXR indicates
Ascending Aortic Aneurysm
Most common CXR abnormality with PE
Atelectasis or decrease in lung volume
New atrial arrhythmias with new onset dyspnea, think
PE
EKG Findings in PE
S1Q3T3 (minority), Atrial Arrhythmias
Atelectasis in PE is due to
decreased surfactant production
Hampton’s Hump is buzzword for
PE
Westermark’s Sign is seen in
PE
Discoid Atelectasis is seen in
PE
No pulmonary vasculature in right lung could be
PE, Pneumothorax
If lack of pulmonary vasculature on CXR, if it was pneumothorax, we:
wouldn’t hear breath sounds; Tympanic on percussion; Likely see collapsed lung
Majority of V/Q Lungs scans are
intermediate probability
Gold standard for PE
Pulmonary Angiography - Invasive, Contrast Dye
If perfusion scan is normal and d-dimer is ___, the possibility of PE or DVT is extremely low
<500
Sensitivity and specificity of D-Dimer
Very Sensivitive, but not specific
Negative D-Dimer means that PE
is highly unlikely
Primary diagnostic modality for PE
Helical CT
Homan’s Sign
Passive dorsiflexion of ankle will cause pain in calf
Best diagnostic modality for lower extremity DVT:
Bilateral lower extremity B-Mode US to demonstrate non-compressability
Gold stand, but not practical test for DVT
Bilateral LE contrast venography
What are you looking for in DVT with B-Mode US
Non-compressability
Best pharmacologic prophylaxis to prevent DVT in patient admitted to ICU
Heparin
Test for Heparin
aPTT
Test for Warfarin
PTT
Assay to measure adequacy of anticoagulation with LMW Heparin (Enoxaparin)
Factor Xa Activity
Most accepted situation for thrombolysis (t-PA)
Large PE w/ Shock
If treated, mortality from PE is
uncommon
What fraction of treated PE patients develop pulmonary hypertension
Very few
Triad for Fat Embolism
Mental Status, Thrombocytopenia, Petechiae
