PE Flashcards
What is Pulmonary Embolism (PE)?
A blood clot that blocks an artery in the lungs, preventing blood flow.
List the risk factors for Pulmonary Embolism (PE).
- Pregnancy
- Obesity
- Immobilisation/surgery
- Long flights
What are the causes of Pulmonary Embolism (PE)?
- A blood clot breaks off from a deep vein in the leg (DVT)
- A blood clot forms in a small blood vessel in the lungs
- A blockage caused by fat from a broken bone, part of a tumor, or air bubbles
What is the PE triad of symptoms?
- Chest pain - PLEURITIC
- Dyspnoea
- Haemoptysis
What are other common symptoms of Pulmonary Embolism (PE)?
- Tachycardia
- Tachypnoea
- Fever
What signs may be observed in a patient with PE?
- Chest clear or crackles
What is the PERC criteria?
- Pulmonary embolism rule-out criteria; all criteria must be negative to rule out a PE.
- Used in low suspision of PE
- If suspicion still high use 2-level PE wells Score
When should the PERC criteria be used?
If there is a low suspicion of a PE (<15%).
What does a Wells Score of < 4 indicate?
PE unlikely.
What does a Wells Score of > 4 indicate?
PE likely; next steps include arranging immediate CTPA.
What should be done if the Wells Score is > 4?
- Arrange immediate computed tomography pulmonary angiogram (CTPA)
- Consider interim therapeutic anticoagulation or a DOAC.
What should be done if the Wells Score is < 4?
- Order D-dimer test.
What to do if D-dimer is positive?
- Start anticoagulants and order CTPA.
What to do if D-dimer is negative?
- Stop anticoagulants and consider differential.
What are D-dimers?
Very sensitive but NOT specific; can be raised in many conditions.
What is the typical finding on a chest X-ray for PE?
Typically normal; positive PE may show wedge-shaped opacification.
What are common positive ECG findings in PE?
- S1Q3T3 (Large S waves (lead I), Large Q waves, inverted T waves (lead III))
- RBBB + right axis deviation
- Sinus tachycardia (most common sign)
What is the advantage of V/Q scanning over CTPA?
Lower dose of radiation.
No contrast - can be used in people with CKD
What is used to determine inpatient or outpatient management for PE?
Pulmonary embolism severity index (PESI) score.
What is the first-line treatment for most patients with PE?
Direct anticoagulant (DOACs) such as Apixaban or Rivaroxaban.
What to use if Apixaban/Rivaroxaban is contraindicated in a PE?
- LMWH + Dabigatran/Edoxaban
- LMWH + Vitamin K antagonists (VKA) e.g. Warfarin.
What is the recommended duration of anticoagulation treatment?
- At least 3 months for all patients
- 3 months for provoked VTE
- 6 months for unprovoked VTE.
What is the ORBIT score used for?
To assess risk of bleeding and monitor patients.
What is the first treatment for PE with haemodynamic instability?
Thrombolysis with Alteplase.
What are the common steps if there is a delay in CTPA?
- Give interim therapeutic anticoagulation (low-molecular-weight heparin)
- Give a DOAC such as Apixaban or Rivaroxaban.
If a CTPA is positive, what does it indicate?
PE present.
If a CTPA is negative, what should be considered?
A proximal ultrasound scan if DVT is suspected.
