Embolism

Question 1

Signs of PE:

Answer 1

Tachycardia
tachypnea
coarse breath sounds
New s4 heart sound

Question 2

Gold standard for dx of PE: and what do you do if these pts have renal failure?

Answer 2

Gold standard: pulmonary angiogram

VQ scan for patients with renal failure (avoids IV contast used in pulmonary angiogram)

Question 3

Regional anesthesia: is it helpful to prevent DVT after surgery?

Answer 3

Only surgical anesthesia from an epidural, but not post-operative analgesia from an epidural loweres the perioperative risk of VTE

Question 4

In an awake and spontaneously ventilating patient, an air embolus will present with:

Answer 4

dyspnea
cyanosis
arrhythmias
hypotension

Question 5

Diagnosis of FES triad:

Answer 5

C: neurologic abnormalities, AMS
P: Petechiae
R: respiratory insufficiency Hypoxemia

Question 6

Treatment plan for FES:

Answer 6

supportive: most will require intubation and mechanical ventilation
TV less than 6 mL/kg, keep PaO2 >60

Question 7

AFE: why does it happen, what will you see? mainstay of tx?

Answer 7

immune response to amniotic fluid contents
Mainstaty of tx: Respiratory failure-intubation and mechanical ventilation
cardiogenic shock: vasopressors
DIC

first pulmonary and systemic hypertension (that pul hypertension can worsen RV failure and contribute to low cardiac output, which may resolve quickly-only to be followed by hypotension due to LV failure

Question 8

Risk factors for AFES:

Answer 8

tumultuous labor 
trauma 
multiparity 
advanced maternal age 
c section