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Respiratory > 1(E): PE > Flashcards

1(E): PE Flashcards

1
Q

Define a PE

A

Occlusion pulmonary arteries by solid, gas or liquid matter

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2
Q

What is the most common cause of PE

A

Thrombus from DVT

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3
Q

Explain incidence of PE with age

A

Increases with age

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4
Q

What factors increase incidence of PE

A
  • Malignancy
  • Active Inflammation: IBD
  • Surgery - particularly to lower limbs
  • Immobility
  • pregnancy
  • COCP
  • HRT
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5
Q

what is the typical triad of symptoms in PE

A
  • Haemoptysis
  • Dyspnoea
  • Pleuritic chest pain
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6
Q

what is a saddle embolus

A

Large embolus that occludes bifurcation of pulmonary arteries

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7
Q

how may a saddle embolus present

A

Shock

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8
Q

what is the most common sign of PE

A

Tachypnoea (90%)

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9
Q

what may be seen on observations in PE

A
  • Tachypneoa
  • Tachycardia
  • Fever
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10
Q

what may be ausculated in PE

A

Crackles
Loud S2
Pleural Rub

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11
Q

what may be seen on palpation in PE

A

Raised JVP

Right ventricular heave

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12
Q

why does a pleural rube occur

A

Inflammation pleura cause loss fluid between and friction as they rub together

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13
Q

when should PE always be considered as a differential

A

Sudden-collapse in person two weeks after surgery

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14
Q

where do majority of PE’s arise

A

DVT above the knee

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15
Q

what should be done first in PE

A

decide whether individual is at high or low-risk of death

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16
Q

how is it deiced whether individual with a PE has a high or low risk of death

A

High risk of death includes:

  • Systolic BP less than 90
  • Decrease in systolic BP of 40 in 15m
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17
Q

if a low-risk of death, how is the person assessed

A

Modified wells score

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18
Q

what is mnemonic to remember components of the modified wells score

A

SHRIMPA

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19
Q

what are the components of the modified wells score

A

Signs and symptoms of DVT

Haemoptysis

Rate of heart >100

Immobility

Malignancy (Palliative, Treatment in past 6 months)

PMH DVT or PE

Alternative diagnosis less likely

20
Q

in the modified wells score - what defines high risk of PE

A

More than 4

21
Q

how are individuals with high probability of PE investigated

A

CTPA

22
Q

what should be checked before CTPA

A

RFTs

23
Q

what is a contraindication to CTPA

A

Contrast Allergy

Poor Renal Function

24
Q

if GFR less than 35 or contrast allergy, what is used

A

V-Q scan

25
Q

what defines low risk of PE

A

less than 4

26
Q

if individual is low risk of PE what is performed

A

D-Dimer

27
Q

if D-dimer is positive, what test is performed to confirm PE

A

CTPA

28
Q

aside from d-dimer, CTPA, what investigation may be ordered for PE

A

ECG

29
Q

what is the most common sign of PE on ECG

A

Sinus tachycardia

30
Q

what other sign of PE can be seen on ECG

A
  • S1T3Q3

- Right bundle branch block with right-axis deviation

31
Q

if suspected delay in CTPA, what should be given

A

LMWH or fondaparinux

32
Q

in PE, what is first line management

A

Oxygen

33
Q

what drugs are given to all individuals with PE

A

Morphine

IV LMWH/ Fondaparinux

34
Q

if someone has a creatinine clearance of less-than 15 what is given as an alternative to LMWH

A

Unfractioned heparin

35
Q

if individual with massive PE, how are they managed

A
  • Resuscitation if in shock

- Thrombolysis with alteplase

36
Q

what is first line if a non massive PE

A

Rivaroxaban

37
Q

If PE is confirmed, how long should rivaroxaban be continued for

A

3W.

Also calculate pulmonary embolism severity index

38
Q

What is an alternative to rivaroxaban

A

Warfarin

39
Q

If a provoked PE, how long is warfarin continued for

A

3-months

40
Q

If an unprovoked PE or active cancer, how long is warfarin continued for

A

6-months

41
Q

how long should LMWH be carried on for

A

5-days or until 24h after INR is greater than 2.0 = whichever is longer

42
Q

summarise management of PE

A
  1. Oxygen
  2. LMWH
  3. Morphine
  4. If haemodynamically unstable resuscitate and thrombolyse. If not, give rivaroxaban or warfarin
43
Q

how are recurrent PE’s managed

A

Inferior vena cava filter

44
Q

what is used to determine severity of PE

A

Pulmonary Embolism Severity Index (PESI)

45
Q

what happens to PESI class I and 2 individuals

A

Early discharge

46
Q

What happens to PESI class 3,4 and 5 individuals

A

Further test with troponin T, ECG and eCHO

47
Q

what are 5 risks of PE

A
  • Recurrence
  • RVF
  • Sudden cardiac death due to PEA
  • Atelectasis
  • Pulmonary infarction caused by embolism if segmental arteries = causing wedge shaped haemorrhage pulmonary infarction

Respiratory (19 decks)

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