Mehlman embolism (PE, amniotic, fat, air) (10-29) (2) Flashcards
PE. simple mechanism?
DVT that has embolized up the venous circulation to the pulmonary arteries
PE. CP + risk?
present as tachy + shorthness of breath
+
has risk factors: post surgery, sedentation (eg due to hip trauma), OCP use, thrombotic disorders (ie FVL, prothrombin mutation, MTHFR).
PE. most specific ecg finding, but ,,non existent” on usmle?
S1Q3T3.
,,will get you questions wrong”.
PE. what ecg will be mentioned?
SINUS TACHYCARDIA
PE. first step management?
heparin
PE. you give heparin –> next?
do spiral CT of chest
PE. Patient is already on warfarin + gets PE –> first step –> next step?
first: do CT
next: IVC filter
DO NOT choose IVC prior to confirming PE on CT.
PE. one question had tPA as the answer for PE in patient with obstructive shock (ie low BP due to PE).
.
PE. Dx imaging in pregnancy?
V/Q scan is done instead of CT
PE. Q. V/Q shows multiple sub-segmental perfusion defects –> what Dx?
recurrent pulmonary embolism
PE. MCC of death?
Ventricular fibrillation -> acute right heart strain from a saddle embolus precipitates the Vfib.
PE. acid/base arrows.?
acute respiratory alkalosis (same as in asthma attack)
CO2 decr. (due to hyperventilation aka incr. RR)
bicarb normal, since it takes time to compensate
pH incr.
PE. one PE Q gave decr. CO2 and decr. pH why?
Patient has lactic acidosis (hence decr. bicarb) due to ischemia from poor perfusion.
HY for USMLE to know, that any type of shock can cause lactic acidosis and low bicarb.
PE. what VQ disturbance?
Dead space
Amniotic. Shorthenes + tachy + gets these symptoms 30s-2 min after delivery of the placenta. answer?
sounds like PE, but since its few min post delivery , its amniotic.
