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PULM 1 > PE > Flashcards

PE Flashcards

1
Q

what is a pulmonary embolism

A

obstruction of pulmonary artery secondary to blood clot

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2
Q

what is a thromboembolis

A

a blood clot on the move

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3
Q

what is Venous thromboembolic disease (VTE)

A

2 manifestations of the same disease

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4
Q

how do PEs cause ventilation perfusion mismatch (V/Q mismatch)?

A

blood cannot get to the lungs to pick up oxygen, so the alveoli has fresh air that isnt reaching the blood

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4
Q

how do PEs cause ventilation perfusion mismatch (V/Q mismatch)?

A

blood cannot get to the lungs to pick up oxygen, so the alveoli has fresh air that isnt reaching the blood

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5
Q

physiologic response to V/Q mismatch

A

hyperventilation which causes respiratory alkalosis

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6
Q

possible consequence of thromboembolus in ASD

A
  • it bypasses the RV and goes to the L side into aorta and into brain causing an embolic stroke
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7
Q

phrase to describe factors that lead to DVT/PEs

A

virchows triad

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8
Q

Virchows triad

A
  • Intimal damage/endothelial injury
  • hemodynamic changes/stasis
  • hypercoagulability (cancer, factor deficiency, pregnancy, etc)
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9
Q

pulmonary vasculature occlusion results in ____ and subsequent ____

A

results in hypoxemia and subsequent pulmonary vasoconstriction

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9
Q

pulmonary vasculature occlusion results in ____ and subsequent ____

A

results in hypoxemia and subsequent pulmonary vasoconstriction

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10
Q

what is the classic triad of PEs that is rare

A

sudden dyspnea
pleuritic chest pain
hemoptysis

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11
Q

most common sign of PE on physical exam

A

tachypnea

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12
Q

lung exam with PE

A

usually normal but rales may be heard

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13
Q

sx of DVT

A

calf or thigh pain, redness, tenderness or swelling

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14
Q

3 common signs of PE on physical exam

A

tachypnea
tachycardia
low grade fever

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15
Q

what is D-dimer? when is it used?

A
  • product of fibrin degradation after clot is broken down
  • used to exclude PE in when probability of PE is low (negative result r/o thrombosis)
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16
Q

what happens if d-dimer is positive?

A

get a chest scan

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17
Q

classic finding of PE on an EKG

A

S1Q3T3

wide deep S in Lead I, Q wave and T wave inversion in Lead III

seen in less than 20% of PEs

18
Q

test that is useful in patients who cannot have contrast or radiation exposure (pregnancy)

A

V/Q scans

19
Q

what was the old “gold standard” imaging for PE? which imaging is now first line diagnostic imaging

A
  • Pulmonary angiography was old gold standard
  • First line CT pulmonary angiography (CTPA)
20
Q

which imaging is used mostly for therapeutic intervention and pre-operative evaluation of pulmonary arteries

A

pulmonary angiography

21
Q

preferred way to determine if PE is likely is via…

A

PERC rule

22
Q

when is wells criteria typically used

A

more subtle presentation or if you can’t PERC out

23
Q

how does the PERC rule work

A

if all 8 things apply then there is only 1% chance of VTE at 45 days. if ANY of the statements do NOT apply to the patient then you cannot perc out

24
Q

try to list all 8 things in PERC rule

dont need to memorize for exam but helps with knowing general PE signs.

A
  • under 50 yo
  • HR under 100
  • O2 sat over 95
  • no prior DVT or PE
  • no trauma or surgery in past 4 wks
  • no hemoptysis
  • no exogenous estrogen
  • no clinical signs of DVT
25
Q

what score is considered PE unlikely via modified wells criteria & traditional wells

A
  • modified is no more than 4
  • traditional– under 2 is “low”, over 6 is high
26
Q

3 signs of poor prognosis

A
  • RV dysfunction on US
  • elevated biomarkers (BNP, NT-proBNP, troponin)
  • shock
27
Q

who is IVC filter indicated for (2)

A
  • For patient w/ PE or DVT + high bleeding risk
  • recurrent PE despite anticoag
28
Q

PE unlikely, now what should you order

A

get D-dimer

29
Q

PE unlikely + D-dimer over 500, now what?

A

get CTPA

30
Q

if CTPA is positive, what does this mean?

A

PE confirmed

31
Q

if CTPA is positive, what does this mean?

A

PE confirmed

32
Q

initial management if patient has stable PE

A
  • can give O2
  • start IV
33
Q

initial tx if unstable hypotension & if resp. support needed

A
  • Hypotension: IV fluids < 1 L & early pressor support (NE)
  • Resp. support: oxygen
34
Q

anticoag preferred in pregnancy or malignancy or liver dz

A

LMWH (enoxaparin) 1-2x daily SQ

35
Q

oral anticoag option

A

factor Xa inhibitors (rivaroxaban or apixaban)

36
Q

anticoag used if unstable, severe renal failure (CrCl under 30), extensive clot burden, obesity or edema

A

IV UFH

37
Q

what is the aPTT target with IV UFH

A

1.5-2.5

38
Q

4 anticoags for if there is hx of /e/o HIT

A

fondaparinux
agatroban
danaparoid
bilvalirudin

39
Q

if there is very large PE or very unstable pt, expert consult with possiblity for what 3 interventions?

A
  • thrombolytic therapy– alteplase
  • catheter directed thrombus removal
  • embolectomy
40
Q

the last ditch effort in treating PE requires expert consultation to consider what?

A

ECMO (extracorporeal membrane oxygenation)

41
Q

typical long term anticoags (5)

A
  • factor Xa in. (rivaro- or apixaban)
  • direct thrombin inhibitors (dabigatran)– needs heparin at start
  • warfarn
  • enoxaparin (LMWH)
  • fondaparinux (subQ factor Xa inhibitor)
41
Q

typical long term anticoags (5)

A
  • factor Xa in. (rivaro- or apixaban)
  • direct thrombin inhibitors (dabigatran)– needs heparin at start
  • warfarn
  • enoxaparin (LMWH)
  • fondaparinux (subQ factor Xa inhibitor)
42
Q

typically we transition enoxaparin or IV UFH to what 3 meds (except in pregnancy)

A
  • warfarin
  • xa inhibitor (rivaro or apixaban)
  • direct thrombin inhibitor (dabigatran)

PULM 1 (8 decks)

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