Chapter 37 Flashcards
What is the differential diagnosis for pleuritic left-sided chest pain?
Pulmonary embolism, pneumonia, acute pericarditis, myocardial infarction
Should emergency orders be put in? Why? What would they be
Yes, because of chest pain; pulse ox, oxygen, IV access, cardiac monitoring ECG, aspirin and nitroglycerin
What should you look at before giving a patient nitroglycerin?
Whether the blood pressure can tolerate it
What is a diagnostic work up for this patient?
D dimer, cardiac enzymes, CBC, BMP, chest x-ray, ABG, spiral chest CT or VQ scan
What would labs find with a patient with pulmonary embolus?
Elevated D dimer, ABG revealing hypoxemia with respiratory alkalosis,
When should heparin be given? When can warfarin be given?
PE should be treated empirically pending diagnostic confirmation. (Spiral CT or VQ scan); When confirmed with imaging, warfarin can be administered
What is PE rule out criteria (PERC)?
No Hemoptosis, no estrogen use, no history of DVT or PE, lack of unilateral leg swelling, no surgery or trauma within the past four weeks, heart rate less than 100, age less than 50, Oxygen saturation greater than 95
How is PE ruled out in the outpatient setting including ED?
If all 8 PERC factors are met and low clinical suspicion
What are the different PE probabilities based on modified well score?
PE unlikely if the score _<4
PE likely if the score >4
What should be done if PE is unlikely? If PE is likely?
Obtain D dimer, if greater than 500 then proceed to CT scan or VQ scan;
Proceed directly to CT or VQ scan
What are the definitive diagnosis test for PE?
Spiral CT pulmonary angiography (CT-PA) or V/Q scan
What anticoagulant therapy is preferred in a patient who is hemodynamically stable and functioning kidney?
LMWH and Warfarin
When is IV UFH used?
In cases of hemodynamically instability, advanced renal failure, high risk of bleeding, or anticipation for thrombolytic therapy
When is thrombolytic therapy used in acute PE?
Due to the risk of fetal hemorrhage, it is used in hemodynamically unstable patients such as massive PE with hypotension
For unstable massive PE patients what is done if thrombolytic therapy is contraindicated or fails?
Surgical or catheter embolectomy
