10 - Venous Thromboembolism Flashcards

1
Q

80% of PE’s start where?

A

In the legs

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2
Q

Blood clot occurs when:

A

Coagulation exceeds the removal by fibrinolysis

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3
Q

Provoked VTE’s

A
Recent surgery
Trauma
Limb or body immobility
Active CA
Infection
Impeded venous flow
Chronic dz
Estrogen use
Pregnancy
> 50 yrs old
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4
Q

Does S1Q3T3 mean PE?

A

No, just heart strain

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5
Q

Survivors of PE go on to develop:

A

Heart dysfunction

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6
Q

Limb immobility risk of DVT:

A
From least to most:
Elbow
Shoulder
Ankle
Knee
Hip
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7
Q

Number one risk factor for PE:

A

Stasis

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8
Q

Risk factors

A
Age
Obesity
Pregnancy
Post-partum
Prior VTE
Solid CA’s
Hematoligic CA’s
Imobility 
Long distance travel
Smoking
CHF 
Stroke
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9
Q

Hallmark of PE is:

A

Dyspnea unexplained by auscultatory findings, ECG changes, or clear alternative diagnosis on CXR

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10
Q

Classis PE pain

A

In the thorax between the clavilces and the costal margin that increases with cough or breathing

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11
Q

PE findings with PE:

A
Tachycardia
Tachypnea
Low SpO2
Mild fever
Wheezing, rales, possible
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12
Q

Pts with DVT c/o:

A

Extremity pain, swelling, cramping

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13
Q

What sign can calf vein thrombosis cause?

A

Homan’s sign - calf pain elicited by passive foot dorsiflexion

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14
Q

What is phlegmasia alba dolens?

A

A swollen, painful, pale or white limb with a proximal venous thrombosis

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15
Q

Does the presence of hypoxemia or dyspnea with clear lungs on exam and imaging confirm PE?

A

No, just SUGGESTS it

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16
Q

MC ECG findings for PE?

A

Nonspecific ST- and T-wave changes

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17
Q

If PE is bad enough, what changes will ECG show?

A

T-wave inversion in V1-V4

Incomplete or complete RBBB

Classic but uncommon -> S1Q3T3

18
Q

Well’s score

A

Slides 37 / 38

Know this

19
Q

D-dimer - what’s the deal with it?

A

Better to order if you don’t think they have a PE

Cuz you get that negative and you’re good

20
Q

What is the PERC?

A

Eliminates the D-dimer

Useful for assessment of likelihood of PE

Gotta be low likelihood and under 50yrs

The rest is on slide 36

21
Q

PERC positive?

A

Get the d-dimer

22
Q

Wells and PERC - what do i need to know?

A

Not how to calculate - just what to do with the numbers

23
Q

Problems with d-dimer?

A

Many false positives and false negatives

24
Q

Wells scores

A

> 6 points = high risk
2-6 points - moderate risk
< 2 points = low risk

Low - go home
Mod / high - CT scan

25
Q

Most common imaging modality for PE?

A

Chest CT angiography

Identifies the presence and location of the clot

Also can pick up other problems if its not a PE

26
Q

Can’t get the CT?

A

V/Q scan - nuclear med scan

Alternate chest imaging for preggos

27
Q

What used to be the gold standard for imaging (before CT?)

A

Direct pulmonary angiography

28
Q

Imaging test of choice for DVT?

A

Ultrasound

29
Q

US for DVT’s?

A

You should be able to compress with the transducer

If you can’t, its bc there’s a clot preventing it

30
Q

Low pre-test probability for DVT?

A

Get the d-dimer

If neg, youre good

If pos, get the US

31
Q

Hight pre-test pos for DVT?

A

Get the US

US pos, txt the DVT

US neg, get the d-dimer

Neg d-dimer, youre good

Pos d-dimer, do US again in a week

32
Q

The two most common options for DVT txt are:

A

UFH or LMWH

That’s the first thing we give, to stabilize the clot (keep it from getting bigger)

33
Q

In addition the starting UFH/LMWH:

A

Remove constrictive clothing, cast, or dressing

Arrange for consultant-delivered catheter-directed thrombolysis

34
Q

If pt has thrombophlebitis

A

NSAIDs

35
Q

What is the only newer oral med approved for both DVT and PE?

A

Rivaroxaban (Xarelto)

36
Q

Massive PE presentation

A

SBP < 90 for >15 mins
Possible AMS

Or <100 with HTN

Or

> 40% reduction in baseline SBP

37
Q

Consider fibrinolysis in which PE pts

A

Cardiac arrest
HOTN
Respiratory failure
Evidence of r-sided heart strain echocardiography

38
Q

In young patients with a large, proximal PE, what’s another option?

A

Surgical embolectomy

Risky

39
Q

Why is post-partum a high-risk for DVT/PE period?

A

Recent trauma
High estrogen
Stasis

40
Q

Hey girl, are you a pulmonary embolism?

A

Cause you make me breathless