PE

Question 0

Which patients should get VQ scan over CT?

Answer 0

#Renal failure patients
#Contrast dye allergy

Question 1

CT versus VQ scan in a pregnant patient?

Answer 1

give CT

CT delivers higher dose of radiation to mother, but a lower dose to fetus

Question 2

In hemodynamically unstable patient with suspected PE – test of choice? If not available? If that is not available?

Answer 2

CT>ECHO>Thrombolytics

Question 3

Stratification test for hemodynamically stable patients?

Answer 3

#Echo
#CT
#Troponins
(#BNP - if normal, 100% chance for no events)
(#RV diameter<LV diameter  - if normal, 100% chance for no events)

Question 4

Echo findings that are independent predictors of 30 day mortality in stable patients?

Answer 4

#RV Hypokinesis
#RV dilation
#Septal bowing

Question 5

When theoretically could a patient be discharged for outpatient management subsequent to PE?

Answer 5

#Stable
#Negative troponin
#No RV dysfunction

Question 6

In Stable patient with RV dysfunction. Consider?

Answer 6

###Thrombolytics - 
#reduces clinical deterioration
#speeds up RV return of function,
#does not affect death rates

Question 7

Only anticoagulation that can be used with thrombolytics?

Answer 7

IV unfractionated heparin

Question 8

When to use percutaneous mechanical thrombectomy?

Answer 8

#High-risk patients with absolute contraindication to thrombolytics
#Patients who have failed thrombolytics

Question 9

When to use vena cava filters?

Answer 9

Contraindications to anticoagulants (in first few days)

Question 10

How soon to start vitamin K antagonists?

Answer 10

First treatment day (with hep bridge)

Question 11

Treatment length for PE?

Answer 11

#Provoked – three months
#Unprovoked – indefinite