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Pulm Final > DVT > Flashcards

DVT Flashcards

1
Q

Virchow’s Triad

A
  • Venous stasis
  • hypercoagubility
  • vessel injury
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2
Q

Where is venous stasis seen?

A

older pts, post-op pts, chronic heart disease

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3
Q

Where is hypercoaguability seen?

A
  • malignancy

- bleeding disorders

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4
Q

major risks of VTE

A
  • family history
  • pregnancy/post-partum
  • prolonged immobilization
  • estrogen therapy
  • obesity
  • factor 5 leiden deficiency
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5
Q

clinically significant VTE begin where?

A

pelvic or lower extremity veins

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6
Q

Small vs large PE presentation

A

Small PE pt may have slight SOB and tachycardia

Large PE pt will have hypotension, hypoxemia (not the first or more common presentation)

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7
Q

what is a sure sign of a DVT?

A

Veins are low pressure and therefore collapsible, a non-collapsibility of the vein under pressure is a sure sign of a DVT

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8
Q

signs of chronic venous insufficiency

A

Permanent leg swelling, black pigmentation on medial malleolus are signs of, chronic venous insufficiency, leads to non healing leg ulcers

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9
Q

MC presentations of PE

A
  • tachycardia # 1
  • coughing/coughing up blood
  • tachypnea
  • SOB
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10
Q

test of choice for PE

A

CT pulmonary angiogram

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11
Q

pts that cannot undergo angiography w/dye should use ( ) as test of choice

A

ventilation-perfusion scan

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12
Q

ABG findings for PE

A
  • hypoxemia
  • respiratory alkalosis
  • Increased Alveolar-Arterial Oxygen gradient
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13
Q

d-dimer is useful for….

A
  • test of exclusion for PE
  • high sensitivity
  • <500 ng/ml PE excluded
  • > 500 order CT angio
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14
Q

what will the CXR look like in a PE pt?

A

normal at first, hampton’s hump is a rare finding (opacities with convex medial margins)

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15
Q

Westermark sign :

A

Dilatation of pulmonary vessels proximal to embolism along with collapse of distal vessels, often with a sharp cut off.

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16
Q

EKG findings for PE

A

S1 Q3 T3, sinus tachycardia

RBBB indicates massive PE

17
Q

V/Q scanning

A

Pt inhales xenon and image of lung is taken
Inject macroaggregated albumin with tecnitium, by the time is reaches the lung the endothelial lining break it down so it is no longer radioactive when it leaves the lungs
The two should be matched, if not then it is an indirect sign of PE
Ventilation without perfusion indicates PE, can be done on any type of pt

No dye needed

18
Q

what is the most accurate test for PE?

A

pulmonary angiogram, requires catheter into right heart

19
Q

test of choice for DVT

A

ultrasound, venous duplex

20
Q

provoked venous thrombosis

A

Venous stasis or trauma

21
Q

unprovoked venous thrombosis

A

unknown cause, do a hypercoagubility workup

more common in younger pts

22
Q

1st line of tx in hospital to stabilize clot and further clotting?
reversal

A

IV heparin,

Reversal - protamine sulfate

23
Q

when to admit pts and how to monitor?

A

admit pts w/moderate to severe PE that are hypoxic and HTN, monitor PTT (b/w 60-90) then bridge w/oral therapy then back off the heparin and the pt can go home

24
Q

what medication is used for pregnant patients or if pt has malignancy (bc they are hypercoaguable)

A

LMWH-can be given as subcutaneous injection, but you do not follow the PTT for monitoring….less incidence of HIT

25
Q

warfarin/coumadin

reversal

A

oral medication, monitor the INR

Reversal - Vit K or fresh frozen plasma (FFP)

26
Q

Rivaroxaban or apixaban

A

can be used for outpatient in the ER for DVT or PE but are hemodynamically stable, do not require initial phase of heparin.
There are no reversible agents for these NOACs
If only a DVT drug of choice is a NOAC

27
Q

If pt has PE, what is your plan of action?

A

check d-dimer then CT, give IV heparin or subcut heparin if pregnant or has malignancy

28
Q

duration of tx for first unprovoked PE

A

RX for at least 3-6 months

29
Q

duration of tx for DVT or PE associated w/cancer

A

: extended therapy recommended over 3 months, or life long till cancer is gone

30
Q

pts that can’t be treated w/anticoagulation or not responding should be treated….

A
  • pulmonary embolectomy
  • IVC filter
  • TPA, alteplase (breaks clot, risk of brain bleed)
31
Q

heparin induced thrombocytopenia

A
  • Develops gangrene of foot/wrist

- treat w/argatroban or lepirudin

Pulm Final (6 decks)

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