PE

Question 1

A 29-year-old pregnant woman presents to the Emergency Department with sudden-onset pleuritic chest pain and dyspnoea. She has recently arrived back from a holiday in New Zealand. From the options, what is her ECG most likely to show, if anything?

Answer 1

Possible ECG signs in patients with pulmonary embolism are:
Sinus tachycardia (the most common)
Signs of right heart strain (not left)
T wave inversion in the anterior leads
S1Q3T3

Question 2

signs

Answer 2

Tachypnea (respiratory rate >20/min) - 96%
Crackles - 58%
Tachycardia (heart rate >100/min) - 44%
Fever (temperature >37.8°C) - 43%

Question 3

PERC

Answer 3

pulmonary embolism rule out criteria

Question 4

if a pe is suspected a what score is carried out

Answer 4

2- level wells score
Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins) 3
An alternative diagnosis is less likely than PE 3
Heart rate > 100 beats per minute 1.5
Immobilisation for more than 3 days or surgery in the previous 4 weeks 1.5
Previous DVT/PE 1.5
Haemoptysis 1
Malignancy (on treatment, treated in the last 6 months, or palliative) 1

if more than 4

Question 5

if more than 4 on wells score what happens

and if positive

Answer 5

CTPA organised and if positive PE diagnosed

if the CTPA is negative then consider a proximal leg vein ultrasound scan if DVT is suspected

Question 6

if under 4 what do you do

Answer 6

arranged a D-dimer test
if positive arrange an immediate computed tomography pulmonary angiogram (CTPA). If there is a delay in getting the CTPA then give interim therapeutic anticoagulation until the scan is performed
if negative then PE is unlikely - stop anticoagulation and consider an alternative diagnosis

Question 7

IVC pe what treatment afterwards

Answer 7

A filter can be placed in the IVC which can minimise the risk of future pulmonary embolisms
posseiro to peritonesum