PE

Question 1

state some locations where PE can originate from?

Answer 1

DVT in proximal leg or iliac veins
right ventricular post MI
septic emboli from R sided endocarditis

Question 2

state some RFs for PE? SPASMODICAL

Answer 2

􏰀 Sex:F
􏰀 Pregnancy
􏰀 Age:↑
􏰀 Surgery (classically 10d post-op straining at stool)
􏰀 Malignancy
􏰀 Oestrogen: OCP/HRT
􏰀 DVT/PE previous Hx
􏰀 Immobility
􏰀 Colossal size
􏰀 Antiphospholipid Abs
􏰀 Lupus Anti-coagulant

Question 3

state some symptoms of PE?

Answer 3

􏰀 Dyspnoea
􏰀 Pleuritic pain
􏰀 Haemoptysis
􏰀 Syncope

Question 4

what blood tests can be done for PE?

Answer 4

FBC, U+E, clotting, D-dimers

Question 5

does PE cause alkalosis or acidosis ?

Answer 5

alkalosis

increase of pH

Question 6

what can CXR of a PE show

Answer 6

normal or oligaemia, linear atelectasis

Question 7

what bundle branch block can PE cause on ECG?

Answer 7

RBBB

Question 8

is V/Q scan used for PE?

Answer 8

no

unless severe renal disease

Question 9

what are the three steps to diagnosing a PE?

Answer 9

1. Assess probability using Wells’ Score
2. Low-probability → perform D-dimers
   􏰁 Negative → excludes PE
   􏰁 Positive → CTPA
3. High probability → CTPA

Question 10

what oxygen should be given for PE patients ?

Answer 10

􏰀 Sit-up

􏰀 100% O2 via non-rebreather mask

Question 11

what medication should be given if the patient is critically ill with massive PE?

Answer 11

Alteplase 50mg bolus stat

Question 12

as well as thrombolysis what other medication can be given?

Answer 12

LMWH Heparin

e.g. enoxaparin 1.5mg/kg/24h SC

Question 13

if systolic BP is >90 what medication should be started after a PE?

Answer 13

warfarin

Question 14

what can be given after a PE if hypotensive even after fluid challenge?

Answer 14

inotropes

Dobutamine

Question 15

how long should graduated compression stockings be given after DVT for and why?

Answer 15

Graduated compression stockings for 2yrs if DVT:

prevent post-phlebitic syndrome (10-30%)

Question 16

what is the target INR after a PE?

Answer 16

2-3

Question 17

what is the duration of warfarin if the PE was provoked or unprovoked?

Answer 17

provoked = 3 months

unprovoked = 6months