L67 Flashcards
What are the deep veins of the legs you should remember for DVT? Where else could clots occasionally live?
Femoral Popliteal Greater saphenous Superficial femoral vein Occasional: - Pelvic veins - Upper extremity (IVs)
What is the physio outcome you’re worried about w/ PE?
Pressure backs up into RV
Increased RV afterload (increased P means harder for RV to pump blood into the lungs)
Net RV failure
Does a PE results in dead space or shunt?
High or low V/Q
Related complication
Most likely dead space
High V/Q
You would think hypercapnea, but even with PE you can hypervent to maintain PaCO2
Why are PE pts hypoxic?
Also areas of low V/Q
Due to vasoactive amines + bronchoconstriction
3 parts of Virchow’s triad
Hypercoag state
Endothelial injury // vascular injury
Venous stasis
Give examples of vascular injury that would increase risk for clot
Surgery
Trauma (fracture)
Post-partum
Vasc catheters
Give examples if stasis that would increase risk for clot
Hospital/bed ridden
Older pts
Cast
Anesthesia
What type of PE is most likely to recur?
Idiopathic
Examples of inherited hypercoag state - do these predict PE recurrence
F 5 Leiden Antithrombin def Prot C def Prot S def Prothrombin gene mutation Do NOT predict PE recurrence
Examples of acquired hypercoag state
Cancer
Hormone replacement therapy
Oral contraceptives
Elevated homocysteine
Vitals for PE
Tachycardia
Tachypnea
Fever
Hypotension if severe
Lung physical exam for PE
Normal
Focal crackles/wheezing
Heart physical exam for PE
Indications of R heart strain:
- Loud P2
- Tricuspid regurg murmur
- RV heave
Dx a DVT
Venous US: compression test
You might also order a D dimer to confirm DVT dx. What is this test?
Clot degraded by fibrinolysis -> release fibrin degradation product into blood
If normal - know not DVT
If abnormal, could be anything
(Good negative predictive value)
Indications of PE on EKG
Large S wave in lead 1
Inverted T wave + small Q wave in lead 3
Inverted T wave in V2 and V3
*More significant if new changes -> suggest R heart dysfxn
What is a submassive PE
R heart dilation as seen on echo
What is massive PE
Hemodynamic compromise:
- Bad O2 sats
- *NOT about clot size - about how bad your heart is effected
What would a VQ scan tell you about a PE?
Probability for PE since mismatch ventilation/perfusion
Good negative pred value:
- VERY sensitive
- Not specific
Aka if positive, could be other things (MI, etc)
Immediate prophylaxis for suspected DVT/PE
HEPARIN
Unfract or LMW
What is the preferred inital anticoag treatment for DVT/PE
Low molecular weight heparin
B/c works fast
How does thrombolytic therapy work differently than other anti-coags?
Directly lyse clot - much higher risk bleeding
- Only use w/ massive PE
Vs. stopping progression of clot
Why bridge initial anti-coag therapy? With what?
Heparin = bridge
Bridge therapy need before PE warfarin gets to needed blood levels
Stop heparin and continue warfarin once INR at therapeutic levels
When would you think about adding an IVC filter?
Pts can’t be anti coag
Recurrent DVT/PE on anti-coags
