40: Pulmonary Embolism - Kersenbrock Flashcards
exogenous or endogenous material migration to the pulmonary vasculature causing various degrees of obstruction
pulmonar embolism
___ % of untreated DVT leads to PE
10-30%
patient with recent fracture…
fat droplet etiiology of PE
virchow’s triad
- hypercoagulability
- endothelial damage
- venous stasis
symptoms of PE
- tachypnea
- hypoxemia
- chest or pleuritic pain
- dyspnea
- anxiety
- cough
- tachycardia
what type of HF can result from PE?
right heart failure
- when the RV can’t genereate enough pressure in systole to push the clot further into the branched vascular bed, it weakens with resultant RHf
what D- dimer level would indicate a PE?
d-dimer level is 550 or greater, the sensitivity for presence of PE may be as high as 98%
a negative d-dimer doesn’t rule out PE if they are deemed high or moderate risk
troponin and PE>
may be elevated if RV has been stressed
ECG changes with PE
sinus tachycarida
-S1Q3T3
what is S1Q3T3?
s wave in lead I
q waves in lead III
inverted t waves in lead III
may indicate PE
CXR reveals: a peripheral conical density with the base opposed to the chest wall
hamptom hump –> on CXR indicates PE
primary diagnositc method for suspected PE
CT angiography CTA
what do you need to check before ordering a CTA?
kidney function – get a BMP
pt has renal failure and suspected PE – what imaging can you use?
ventialtion-perfusion scan
normal scan can exclude PE but not very sensitive to diagnosis
“gold standard” for PE diagnosis
pulmonary arteriography
reserved for pts w/ whom uncertainty remains after CTA
