PE Flashcards
Well’s Score Interpretation?
Low chance if 4
Low chance it =4
Wells score criteria?
Clinical signs of DVT– 3 points
PE most likely – 3 points
Surgery in past 4 weeks – 1.5 points
Tachycardia– 1.5 points
Demobilization for the past three days – 1.5 points
Previous PE/DVT – 1.5 points
Hemoptysis – 1 point
Malignancy – 1 point
Wells score for DVT’s?
Alternate diagnoses at least as likely: -2 points
Active cancer Previous DVT Calf Swelling >= 3 cm Entire leg swelling Unilateral Swollen superficial veins Unilateral pitting edema Paralysis or cast mobilization Bedridden >3 days Major surgery in past 12 weeks
Tenderness:
Wells score for DVT’s interpretation?
High risk if >2
Moderate risk if 1 – 2
Low risk if <1
Use Inferior Vena cava filter if?
- Active bleeding or other contraindication for anticoagulation
- Recurrent DVT/PE despite therapeutic anticoagulation
PE – most common symptom, most frequently observed sign?
Dyspnea, tachypnea
Most appropriate diagnostic step for patient with suspected PE?
CT with contrast (In patient with severe renal disease or contrast allergy use V/Q scan)
The most common inherited hypercoagulable disorders?
Factor V Leiden and prothrombin gene mutations
Why is malignancy a predisposing condition for DVT’s?
Thought to generate thrombin or secrete procoagulants
Most common site of Clot formation?
The deep, proximal lower extremity veins
Obstruction to the pulmonary arteries cause?
- Platelets release serotonin – elevating pulmonary vascular resistance (RV Dilation)
- V/Q mismatch
- Reflex bronchoconstriction increases airway resistance
- Edema/hemorrhage/loss of surfactant further decreases lung compliance
Signs of massive PE versus smaller PE?
Syncope, hypertension, cyanosis
versus
pleuritic pain, cough, hemoptysis
Classical physical exam findings of PE?
- Tachycardia
- Right ventricular dysfunction – Tachypnea, left parasternal lift, accentuated pulmonic component of second heart sound, systolic murmur increases that with inspiration
Course to initiate warfarin therapy?
Use unfractionated heparin, Lovenox, or fondaparinux for five days while overlapping with warfarin until INR is 2.5 for two days
Treatment length for warfarin?
Provoked DVT of calf or upper extremity: 3 months
PE or provoked DVT of the proximal leg: 6 months
unprovoked DVT/PE with ongoing risk factors (cancer, antiphospholipid): indefinite
D-dimer value in patients with PE?
> 500
Most common ECG findings in PE?
Other findings?
Sinus tachycardia
#New Onset AFIB #T-wave conversions in anterior leads (V1 – V4) #S1 Q3 T3
Most common CXR abnormality in PE?
Others?
Usually normal but If abnormality - atelectasis
- Westermark sign – prominence of central pulmonary artery with decreased pulmonary vascularity
- Hampton hump – a peripheral wedge shaped density above diaphragm
- Palla sign - Enlargement of right descending pulmonary artery
Primary therapy for PE?
Patients with right heart failure or hypotension (high risk): Thrombolysis or surgical embolectomy
Otherwise: anticoagulation With unfractionated heparin or Lovenox or Fondaparinux
Usual cause of death from PE?
Right heart failure
Virchow’s Triad?
Trauma, hypercoagulability, venostasis
Prerequisite for a V/Q scan?
Normal CXR (if abnormal, get CT)
When to use direct thrombin inhibitor for anticoagulation instead of heparin?
Heparin-induced thrombocytopenia
