PE Flashcards
Features
o Acute dyspnoea
o Pleuritic chest pain (on inspiration)
o Haemoptysis
o Syncope
D -dimer has a low specificity - also be raised in?
infection
malignancy
inflammation
sensitive and specific and is the test of choice for high-risk patients?
CTPA
test of choice for low risk patients with +ve D-dimer.
CTPA
In patient’s with unprovoked PE (no known provoking risk factors, consider investigation for
underlying malignancy.
. Patients >40yrs consider what Ix?
abdo-pelvic CT and mammography in women.
Assess the clinical probability of a PE using what score?
modified Well’s score
if modified Wells score >4 - whats your next step?
Immediate CTPA or treat empirically with LMWH without delay
if modified Wells score <4 - whats your next step?
Do D-dimer
if +ve = do immediate CTPA or LMWH Tx
if -ve = consider alternative Dx
Mx of PE
most PE deaths occur within one hour
Tx acronym:
Oh
My
Life!
if haemodynamically unstable or hypotensive consider what?
long term Tx?
how long are you on long term Tx for unprovoked PE?
how long are you on long term Tx for Provoked PE?
how long are you on long term Tx for pregnancy?
Oxygen
Morphine IV + antiemetic
LMWH or fondaparinux (5 days)
Thrombolysis - Allteplase IV
long term Tx = DOAC or warfarin
DOAC or warfarin
Unprovoked PE = DOAC for 3 months then reassess
Provoked PE = on DOAC fro >3 months
Pregnancy = on DOAC till end of pregnancy
A 43-year-old lady presents with central chest pain, worse on deep inspiration, and shortness of breath. After her history and examining her, you suspect a pulmonary embolus (PE). Her Wells’ score is 9. You plan to do a CTPA, but the radiologists request you order one further investigation prior to a CTPA. What investigation is this likely to be?
US doppler of leg CXR CT chest V/Q scan D-dimer
CXR
A chest xray is an essential investigation when investigating a PE
A 75-year-old woman who has been in hospital for the treatment of community acquired pneumonia develops new shortness of breath. CT pulmonary angiogram reveals a right sided pulmonary embolus.
What will the arterial blood gas most likely show?
metabolic acidosis
metabolic alkalosis
respiratory acidosis
respiratory alkalosis
respiratory alkalosis
Pulmonary embolism causes hyperventilation, causing a drop in arterial carbonic dioxide partial pressure and thus alkalosis
A 45-year-old female develops pleuritic chest pain following a hysterectomy 10 days ago. You admit her to the acute medical unit and a CTPA confirms a pulmonary embolism. There is no previous history of venous thromboembolism. How long should the patient be warfarinised for?
3 months
6 months
4 weeks
life long
3 months
As this woman has a temporary risk factor for a thromboembolic event the recommended period of anticoagulation is 3 months.
A 61-year-old lady is admitted to the emergency department with shortness of breath. She has no past medical history and takes no regular medications. On examination she has a pulse rate of 111 bpm, a respiratory rate of 29/minute, a blood pressure of 128/86 mmHg, a temperature of 36.2 ºC, normal heart sounds, a clear chest, soft and non-tender calves and her ECG shows a sinus tachycardia.
Which of the following investigations would be most appropriate to make a diagnosis?
d-dimer levels
high resolution CT thorax
CTPA
echocardiogram
CTPA
Tachycardia and tachypnoea with no signs: think PE
A 72-year-old man who is known to have chronic kidney disease stage 4 is admitted to the Emergency Department. Since yesterday he has felt short-of-breath on exertion and has been coughing up blood. On examination he is tachycardic at 110/min with a normal chest examination. What is the most suitable initial imaging investigation to exclude a pulmonary embolism?
V/Q scan CTPA Pulmonary angiography MRI thorax ECHO
V/Q scan
Computed tomographic pulmonary angiography (CTPA) is now used first-line to investigate the possiblity of pulmonary embolism. Patients with renal impairment however should be offered Ventilation-perfusion (V/Q) scans as the contrast media used during CTPAs is nephrotoxic.
