22 Pulmonary Embolism Flashcards

1
Q

What is a pulmonary embolism?

A

Obstruction of a pulmonary artery or one of its branches

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2
Q

Where do pulmonary emboli commonly originate?

A

Deep veins of lower limb, pelvis or abdomen

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3
Q

What can the embolism be made up of (ie what can embolise)? (6)

A

Fat embolism due to long bone fracture

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4
Q

How are fat emboli usually caused?

A

Fat emboli commonly occur after fractures to the long bones of the lower body

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5
Q

How are cerebral air emboli usually caused?

A
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6
Q

Where do the majority of pulmonary emboli come from?

A

90% from DVT in legs

Esp: popliteal vein and pelvic veins

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7
Q

What are the risk factors for a pulmonary embolus?

A

Same as for DVT:

  1. Stasis / turbulence of blood flow
  2. Blood hypercoagulability
  3. Endothelial injury

Vichow Triad

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8
Q

List some risk factors that increase someones risk of developing a thromboembolism (eg pregnancy).

A
  • Increased age- increased risk (culmination of factors)
  • HRT
  • Longhaul travel: stasis, dehydration
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9
Q

If someone with a DVT has no identifiable risk factors, what needs to be considered?

A

Undetected malignancy

  • Eg. Cancer might secrete pro-thrombotic factors
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10
Q

Give examples of conditions that should be screened for if a patient is in hypercoagulable state.

A
  • Deficiency of natural blood thinners
    • Antithrombin III deficiency
    • Protein C or Protein S deficiency/resistance
  • Lupus anticoagulant
  • Homocystinuria
  • Malignancy
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11
Q

What % of people with pulmonary emboli will suddenly die?

A

20%

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12
Q

What are the symptoms of a pulmonary embolism?

A

Patient can look and feel asymptomatic- make sure to check if high risk

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13
Q

What are the physical signs of a pulmonary embolism?

A

Diaphoresis= sweating

Thrombophelbitis= (inflammation of a vein due to thrombus)

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14
Q

If a patient presents with the symptoms of a pulmonary embolism, what might be the diffential diagnoses?

A

Pleurisy= pleuritis (sharp chest pain)

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15
Q

What investigations can be done if a patient has a suspected pulmonary embolism?

A
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16
Q

Outline the how pulmonary emboli are treated.

A
  • Oxygen
  • Low molecular weight heparin
    • Stop thmobus propagatin and allows body to lyse thrombus
      • BUT watch out for heparin induced thrombocytopenia
  • Percutaneous catheter- thrombectomy
  • Surgical pulmonary embolectomy
17
Q

What can we do to prevent the occurence of pulmonary emboli in patients?

A
  • Manage risk factors (eg HRT, obesity, travelling etc)
  • DVT prophylaxis after surgery/for malignancy