PE Flashcards
What are symptoms of PTE?
SOB, collapse, pleuritic chest pain, heamoptysis and sudden death.
What are the signs of PE?
Tachypnoea, wheeze, pleural rub and signs of pleural effusion
hypotension, tachycardia, arrest and fourth heart sound,
Oligemia (water mark) on CXR.
What investigations do we do for PE?
ABG’s and D dimers.
CXR, VQ scan and CTPA (CT pulmonary angiogram).
echo, angiography and ECG.
What is the time frame for doing a VQ scan in PE?
What is a con of the test?
Within 48 hours of event.
It is poor at discriminating between PE and background lung disease
What is a CTPA? How is it done and what are the disadvantages?
CT pulmonary angiogram.
Inject IV contrast and get to hold breath.
It is poor for peripheral lesions.
What are we looking for in an echo for PE?
Right sided heart strain and pressures.
What are the objectives of PE treatment?
Prevent death.
Prevent post thrombotic syndrome.
Prevent recurrent venous thromboembolism.
Minimise side effects and inconvenience.
What is the recommended treatment for a massive PE?
Thrombolysis or surgery.
What is the recommended treatment for a minor PE with RV dysfunction?
Anticoagulants and thrombolysis.
What is the recommended treatment for a major PE without RV dysfunction?
Anticoagulants.
What is the recommended treatment for a minor PE?
Anticoagulants.
What anticoagulants do we give for PE?
LMWH and warfarin.
Initial treatment with LMWH.
Induction period with LMWH of 5 days is associated with a lower rate of recurrent PE.
Stop heparin when INT is greater than 2.
Optimal range of warfarin therapy is still to be established. Should continue for at least 3 months.
What thrombolytic therapy do we use for PE?
TPA.
What are the effects of TPA on PE?
Accelerates resolution but has no effect on the extent of resolution. No effect on frequency of recurrence and may reduce subsequent pulmonary HT.
What are the indications for an IVC filter?
Recurrent PE despite anti coagulation.
PE When anti coagulation cannot be used
High risk thrombolysis of DVT e.g. Plegmasia dolens.
What surgery do they do for PE?
Endartectomy for chronic thromboembolic pulmonary hypertension.
Pulmonary embolectomy.
What vitamin K antagonists do we use for PE?
Warfarin and phenindone
What are new oral anti thrombin agents we can use for PE?
Dabigatran and anti XA e.g. Apixaban and rivaroxaban.
What is UFH?
Unfractioned heparin.
What are two heparin analogues?
Hirudins and danaparoid.
What are the mechanisms of action of anticoagulants?
Prevent clot formation and extension.
What are the mechanisms of action of anti platelet drugs?
Interfere with platelet activity.
What are the mechanisms of action of thrombolytic agents?
Dissolve existing thrombi.
What are the indications for warfarin?
Post MI, recurrent MI, stroke or systemic embolisation.
Prevention and treatment of cardiac embolism.
Prophylaxis and/or treatment of:
Venous thrombosis and its extension.
Pulmonary embolism.
Thrombolytic complications associated with AF and cardiac valve replacement.
How do we calculate INR?
Patients PT in seconds divided by mean normal PT in seconds.
Multiply this answer by the international sensitivity index.
What are contradictions to warfarin therapy?
Pregnancy.
Risk of haemorrhage greater than benefit of treatment.
Uncontrolled alcohol/drug abuse.
Unsupervised dementia/psychosis.
What patient education should we give about anticoagulation?
Teach safety, discuss regular INR, counsel on other medications, alcohol and diet. Discover strategies for improving compliance.