Chapter28-Pulmonary Vascular Disease Flashcards
What is a pulmonary embolism
When a fragment of thrombus in the venous system travels to the lungs
What are risk factors for PE
Advanced age Post op Trauma Prolonged bed rest Long period of travel Dvt
Pe pathophysiology
Sudden obstruction of pulmonary artery causes a decrease in blood flow to the lung
This increases dead space
Causes bronchoconstriction
And decreases production of surfactant
What does the body to to compensate for pe
Increases rr which worsens dyspnea
Hypocapnia causes bronchial vaso?
Vasoconstriction
A-a gradient will _____ with pe
Increase
When does pulmonary hypertension occur with pe ?
When 50% or more of the pulmonary vascular bed is occluded
When mean pulmonary artery pressure exceeds __ hemodynamic compromise and death occur
40
If hypotension is present with an increased cvp what should be suspected?
Pulmonary embolism
Symptoms with pe
Dyspnea Pleuritic chest pain Cough Hemoptysis Tachypnea Tachycardia
What do ABGs with pe typically present with
Hypoxemia and hypocapnia
What can be used to exclude pe diagnosis
D-dimer test
What non invasive tests can be used to diagnose pe
V/q scan
Ct
Treatment for patients at moderate risk of dvt
Prophylaxis with heparin, enoxaparin or dalteparin
Mechanical prophylaxis
Prevention of dvt in patients at high risk for developing
Apixaban Rivaroxaban Heparin Warfarin Mechanical prophylaxis
What patients are Moderate risk for dvt
Abdominal or pelvic surgery
Bed rest
High Bleeding risk
What patients are at high risk for dvt
Hip or knee surgery
Major trauma
Hip fracture
Spinal cord injury
Mechanical measures to prevent dvt include
Early ambulation
Compression socks
Electrical stimulation of calf muscles
What is pulmonary hypertension
Mpap greater than 25 at rest
What is the target Inr with anti coagulation for pulmonary hypertension
2-3
Why is it important to maintain SpO2 above 90 in ph
Because hypoxemia causes pulmonary vasoconstriction
What are current treatment options for ph
Ccb
Prostanoids
Endothelin receptor antagonists
Pde-5 inhibitors
When are diuretics indicated
For right ventricular volume overload
When may digoxin be used
For patients with refractory right ventricle failure or for a fib or flutter
