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P&T Block 3 Pulm & GI > L67 > Flashcards

L67 Flashcards

1
Q

What are the deep veins of the legs you should remember for DVT? Where else could clots occasionally live?

A 
Femoral
Popliteal
Greater saphenous 
Superficial femoral vein 
Occasional:
- Pelvic veins
- Upper extremity (IVs)
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2
Q

What is the physio outcome you’re worried about w/ PE?

A

Pressure backs up into RV
Increased RV afterload (increased P means harder for RV to pump blood into the lungs)
Net RV failure

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3
Q

Does a PE results in dead space or shunt?
High or low V/Q
Related complication

A

Most likely dead space
High V/Q
You would think hypercapnea, but even with PE you can hypervent to maintain PaCO2

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4
Q

Why are PE pts hypoxic?

A

Also areas of low V/Q

Due to vasoactive amines + bronchoconstriction

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5
Q

3 parts of Virchow’s triad

A

Hypercoag state
Endothelial injury // vascular injury
Venous stasis

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6
Q

Give examples of vascular injury that would increase risk for clot

A

Surgery
Trauma (fracture)
Post-partum
Vasc catheters

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7
Q

Give examples if stasis that would increase risk for clot

A

Hospital/bed ridden
Older pts
Cast
Anesthesia

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8
Q

What type of PE is most likely to recur?

A

Idiopathic

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9
Q

Examples of inherited hypercoag state - do these predict PE recurrence

A 
F 5 Leiden
Antithrombin def
Prot C def
Prot S def
Prothrombin gene mutation
Do NOT predict PE recurrence
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10
Q

Examples of acquired hypercoag state

A

Cancer
Hormone replacement therapy
Oral contraceptives
Elevated homocysteine

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11
Q

Vitals for PE

A

Tachycardia
Tachypnea
Fever
Hypotension if severe

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12
Q

Lung physical exam for PE

A

Normal

Focal crackles/wheezing

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13
Q

Heart physical exam for PE

A

Indications of R heart strain:

  • Loud P2
  • Tricuspid regurg murmur
  • RV heave
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14
Q

Dx a DVT

A

Venous US: compression test

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15
Q

You might also order a D dimer to confirm DVT dx. What is this test?

A

Clot degraded by fibrinolysis -> release fibrin degradation product into blood
If normal - know not DVT
If abnormal, could be anything
(Good negative predictive value)

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16
Q

Indications of PE on EKG

A

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

17
Q

What is a submassive PE

A

R heart dilation as seen on echo

18
Q

What is massive PE

A

Hemodynamic compromise:

  • Bad O2 sats
  • *NOT about clot size - about how bad your heart is effected
19
Q

What would a VQ scan tell you about a PE?

A

Probability for PE since mismatch ventilation/perfusion
Good negative pred value:
- VERY sensitive
- Not specific
Aka if positive, could be other things (MI, etc)

20
Q

Immediate prophylaxis for suspected DVT/PE

A

HEPARIN

Unfract or LMW

21
Q

What is the preferred inital anticoag treatment for DVT/PE

A

Low molecular weight heparin

B/c works fast

22
Q

How does thrombolytic therapy work differently than other anti-coags?

A

Directly lyse clot - much higher risk bleeding
- Only use w/ massive PE
Vs. stopping progression of clot

23
Q

Why bridge initial anti-coag therapy? With what?

A

Heparin = bridge
Bridge therapy need before PE warfarin gets to needed blood levels
Stop heparin and continue warfarin once INR at therapeutic levels

24
Q

When would you think about adding an IVC filter?

A

Pts can’t be anti coag

Recurrent DVT/PE on anti-coags

25
Q

Treat a BIG ASS CLOT

A

Embolectomy

Surgical or IR

26
Q

What chronic thrombo-embolic pulmonary HTN?
Dx
Treat

A 
An acute PE doesn't dissolve or recur frequently 
Leads to pulmn HTN
Dx w/ VQ scan
Manage as you would other PEs:
- Anti-coag
- Maybe surg removal of clots
- Pulm HTN meds
27
Q

What is hemoptysis

A
  1. Massive amt blood (def varies)
  2. Life threatening:
    - Abnormal gas exchange
    - Hemodynamic instability
    - Need immediate stabalization and treatment
28
Q

If hemoptysis is due to diffuse alveolar hemorrhage (bleedind distally) - what are 3 possible causes?

A
  1. Diffuse alveolar damage (DAD)
  2. Capillaritis = WBC infiltration of the capillaries
  3. Bland aka idiopathic
29
Q

If you see capillarits in the lungs, where else should you check for vascular abnormalities?

A

Kidneys!!

Pulm renal syndromes are common

30
Q

Treat capillaritis

A

Immune suppression so WBC stop invading capillaries

P&T Block 3 Pulm & GI (31 decks)

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