PE Flashcards
Define an embolus
A mass that cannot move forward.
Other names for a thrombus
Blood clot
What can be PE
Tumor
Blood clot
Air
Fat
Name the different types of embolisms
Saddle
Lobar
Segmental
Sub-segmental
What are the adverse effects of reduced perfusion to the lungs
Decreased surfactant production
Decreased lung compliance/atelectasis
Further mismatch
Clot formations/ virchow’s triad
Venous stasis
Hypercoagulability
Injury of endothelial cells
What does a “stitch in your side indicate” ?
Potentially a PE
How do tumors cause PE’s
Multiple myeloma causes bones to brake off
Tumors can release procoagulants
What causes venous stasis
Immobility
Ex. Long flights
medical conditions
How does pregnancy cause PE
Obstruction of venous return by enlarged uterus
Why are hospitalized patients at risk of a PE
Immobilized by sickness
Maybe on a vent
What surgeries have a high risk for PE
Hip surgery
Pelvic surgery
Knee surgery
Some obstetric or gynecologic procedures
What types of trauma can cause a PE
Bone fracture of lower extremities
Extensive injury of soft tissue
Postoperative or postpartum states
Extensive hip or abdominal operation
Vascular conditions that cause venous stasis
CHF
Varicose veins
Thrombophlebitis
Risk factors for hypercoagulation
Oral contraceptives (increase clotting factor)
Polycythemia
Factor V Leiden
Risk factors for endothelial damage
Smoking
Hypertension
Atherosclerosis
What is the presentation with a massive PE
Sudden onset
Enormous reduction in BP and oxygenation
Quick fatality
How long might it take people to present symptoms of a PE
Days or weeks
What classifies a massive PE
Equal or greater than 50% vascular occlusion and vasoconstriction
Decreased (LV) and (RV) output
Systematic hypotension
Cardiovascular collapse
Presentation for a massive PE
Sudden dyspnea
Tachycardia
Hypotension
Hemodynamic instability
Pleuritic chest pain (may radiate)
How does submissive PE Develop
May be slow
Pulmonary hypertension over years resulting from pulmonary embolism
What do you do with patients with low risk of a PE
Monitor and assess
Whose at risk for a septic embolism
Intravenous drug users
What causes septic embolism
Vegetation on tricuspid valve or pulmonary valve leads to vegetation entering pulmonary arteries
Emboli lodges in small aw causing infection and growing abscesses, infarcts, and cavities
What is used to rule out low suspension PE patients
PERC Rule
Wells score
(Should they go home)
What do you do if a patient presents with high clinical suspicion
Move quickly toward definitive testing and treatment.
What are the risk of PE diagnostic studies
Expensive
Potentially inconclusive
Potentially harmful
What is the gold standard for PE diagnosis
CT pulmonary angiogram
Explain a CT angiogram
Injects a contrast into veins to make them seem opaque
Can cause kidney damage
Look for abrupt cut off
How do you test for a PE for a pregnant or pt. W/ kidney disease
Ventilation/perfusion scan
How does the V/Q scan work
VENTILATION:
A patient inhaled a Nebulizer radioisotope w/ short half life
Use nuclear medicine scan to view AW
PERFUSION:
Inject isotope and scan pulmonary vessels
Shortcoming of the V/Q scan
Many test will have indeterminate results
How is sonograms used to diagnose PE
Ultrasound imaging of lower extremity can detect deep vein thrombosis
Cardiac ultrasound can detect right heart strain
What is the D-dimer
A protein fragment left in the blood after the clot degrades by fibrinolysis
How much D-dimer does not indicate PE
Less than or equal to 500ng/mL
Secondary to PE when might a patient have D-dimer in their blood
After surgery
Sensitive, but not specific
What Wells score indicates high probability of PE
> 6
What Wells score indicates moderate probability of PE
2-6
What Wells score indicates low probability of PE
< 2
What role does “PERC” play in the diagnosis of PE
Should a patient go home/ rule out criteria
What patients get the PERC test
Low risk for PE
What happens if a patient is flagged for a PERC test
D-dimer test is done, which can lead to imaging
How many yeses do you need for the PERC test for further testing
Only one yes
What are the managements for acute PE
Surgery
Thrombolytics
Anticoagulant
What surgery is done for patients with PE
Thrombectomy
Who as thrombectomys done
Hemodynamic unstable patients
How is a thrombectomy
A catheter is advanced through right femoral vein
Either: suction, or fragmentation and suction
Mortality is relatively high
What is a thrombolytic
Used to breakdown blood clots indiscriminately
What does PERT stand for
Pulmonary embolism response teams
Name the thrombolytic
Tissue plasminogen activator (tPA)
(Applied at site)
What anticoagulant is given
Unfractionated heparin (IV)
Hold until thrombolytics are complete
What are the managements for stable PE patients
Heparin and supportive care
What long term prophylaxis is given to stable PE patients
Low-molecular-weight heparins
(Oral)
Enoxaparin (lovenox)
Warfarin (Coumadin)
Apixaban (Eliquis)
What can we do for the heart of stable PE patients
Inferior Vena Cava filter (Greenfield filter)
(Device can migrate, cause a thrombosis)
What are chronic Mgt. of PE risk
Walking
Exercise while seated
Drink fluids
Compression socks
Pneumatic compression on legs
