4) PE Flashcards

1
Q

Causes of PE?

A

Usually arise from a VT in the pelvis or legs

Rare causes: RV thrombus (post MI), septic emboli, fat, air, amniotic fluid, tumour, parasites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk Factors for PE?

A
Recent surgery
Thrombophillia eg antiphospholipid syndrome
leg fracture
prolonged bed rest/reduced mobility
malignancy
pregnancy/post partum/ pill/ hrt
previous PE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clinical features of PE?

A

depend on size and distribution: small can be asymptomatic, large sudden death

Acute breathlessness, pleuritic chest pain, haemoptysis, dizziness, pyrexia, tachy (both), hypotension, raised JVP, low cap refil

look for sign of dvt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tests in PE?

A

Depend on the wells score really
FBC, U+E baseline clotting
ABG may show low o2 and CO2
CXR: may be normal, wedge opacity, small effusion, linear atelectasis
ECG: normal, tachy, RBBB RV strain (inverted T 1-4) S1Q3T3 rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What type of resp failure can you get in PE?

A

Type one due to V/Q mismatch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ix that can be done in PE?

A

U+Es, clotting, FBC
D Dimer- low specificity but high sensitivity- good for exclusion
CTPA- Gold standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What else can raise a D Dimer?

A

Thrombosis, pregnancy, infection, malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of Large PE?

A

Oxygen if hypoxic

Morphine 5-10mg if distressed

Consider 50mg alteplase if periarrest

IV access and start heparin, LMWH of UFH

Check BP:
If <90, start fluids and contact ICU
If <90 after 30-60 mins and defs and no C/I then thrombolise

if >90
Start warfarin eg 5-10mg PO and continue until inr 2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management after stabilisation of PE?

A
  • Prevent further embolism with compression stockings
  • LMWH with warfarin until INR 2-3
  • If obvious cause, then continue for 6 weeks
  • No obvious cause, continue for 6 months, longer if malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When do most deaths occur in PE?

A

Within the first hour, get on and treat it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Prevention of PE?

A

Early post op mobilisation is the best method
Also: TED stockings
LMWH
Avoid OCP if at risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do we decide if a PE is likely?

A
WELLS SCORE:
S+S of DVT?  3
Alt diagnoses less likely?  3
HR>100  1.5
Immobile 3 days/surgery<4weeks 1.5
previous   1
Haemoptysis   1
Malignancy  1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the Wells cut off?

A

more than 4 is likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

management if PE likely?

A

CTPA, if there will be a delay, give LMWH in meantime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management if PE unlikely?

A

DO a d dimer, if -ve happy days, if +ve CTPA and anticoagulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If CTPA neg in a likely PE?

A

if DVT suspected do US doppler

17
Q

When can thrombolysis be used?

A

If haemodynamically unstable

Clinical grounds alone if arrest is imminent

18
Q

Absolute C/I to thombolysis?

A

-previous haemorrhagic stroke
-ischaemic stroke in last 6mo
CNS damage or neoplasms
Recent major surgery/head injury
GI bleed recent
current known bleeding

19
Q

Relative C.I to thrombolysis?

A
TIA
on oral ac
pregnancy or 1 week post partum
traumatic resus
advanced liver disease
active peptic ulcer
refractory HTN
20
Q

PE in pregnancy?

A

Be really careful, go for US of leg if leg symptoms and treat if positive

CXR for abnormalities before CTPA, V/Q if normal

Warfarin is teratogenic so do not use
Refer to obs for delivery issues on LMWH