PE Flashcards
What other rarer causes can occur?
Right ventricular thrombus (post MI)
Septic emboli (infective endocarditis)
Fat, air, amniotic fluid, neoplasticism cells, parasites
Name 5 risk factors for PE?
Recent surgery Thrombophilia Fracture Bed bound/immobile Malignancy Pregnancy Past thrombotic event eg PE
Symptoms of PE?
Acute breathlessness, pleuritic chest pain, haemoptysis, dizziness, syncope
Signs of PE include?
Pyrexia, cyanosis, tachypnoea, tachycardia, hypotension, raised JVP, pleural rub, pleural effusion, any signs of DVT
What investigations would you do?
U+Es, FBCs, clotting screen, D-dimer, ECG, CXR, ABG, CTPA (CT pulmonary angiography)
What might you see on a ECG?
Normal, sinus tachy, RBBB, AF, Q and inverted T waves in lead III, deep S wave in lead I
CXR will often show what features?
Often normal, decreased vascular markings, small pleural effusion, wedge shaped are of lung infarction, atelectasis (complete or partial collapse of the lung)
ABG will show what?
Picture of hyperventilation and poor gas exchange; low O2, low CO2 and often low pH
What is the advantage of conducting a D-dimer test?
It has very high sensitivity but very low specificity, this holds the advantage that if someone gets a normal D-dimer it can exclude a PE
What is the advantage of conducting CTPA?
Highly sensitive and specific
What scan might you do to aid diagnosis if CTPA unavailable?
V/Q scan
What is the first step of management, as with any acute presentation?
ABCDE assesment
What is the second step of managing a PE?
Give oxygen high flow 10-15L/min (probs use a non-re breathing mask)
What would you do after giving oxygen if your patient is in pain?
Give morphine 10-15mg IV and metoclopramide
If your patient is already critically ill at this point or a massive PE has been found, what should you consider doing?
Give thrombolysis now! (50mg bolus of alteplase)
If not critically ill and patient has been given analgesia and oxygen, what is the next step?
Give IV LMWH or unfractionated heparin
Your patient is oxygenated, received analgesia and heparin what measurement should you take to guide your treatment from this point?
Blood pressure
The patient has a systolic above 90 what is the next treatment step?
Start loading dose of warfarin (5-10mg PO) and confirm diagnosis
Your patient has a systolic below 90 what is the next step?
Start rapid colloid infusion and send to ICU
If systolic remains below 90?
give doubutamine and more colloid
If BP is still below 90 then what should you do?
IV adrenaline
Your patient still has a systolic below 90 after 30-60 minutes of standard treatment, it is clinically definite PE what should you do?
Give thrombolysis (if no CIs to thrombolytics)
After patient is stable, what long term management steps should be taken?
Compression socks, LMWH while warfarin takes affect to bring INR above 2, treat any underlying cause
Prevention strategies?
Early post-op mobilisation, TED stockings, avoid the contraceptive pill, good anti coag
Where do pulmonary embolisms usually originate from where?
A DVT in the legs or pelvis
What is the problem with CTPA?
Highly nephrotoxic
