PE

Question 1

PE RFs

Answer 1

Recent surgery
Prolonged immobility
Leg fracture

Thrombophilia
Malignancy
Oestrogens (pregnancy, OCP, HRT)

Previous PE

Question 2

PE presentation (large emboli)

Answer 2

Acute breathlessness
Pleuritic chest pain
Haemoptysis
Tachypnoea/cardia
Hypotension
Raised JVP

Question 3

PE tests

Answer 3

ABG may show dec PaO2 and PaCO2
CXR may show dilated pulmonary artery, oligaemia of affected segment or nothing
CTPA is diagnostic
D-dimer has low specificity but high sensitivity

Question 4

PE prevention

Answer 4

Investigate unprovoked for thrombophilia etc
Give heparin to immobile patients
Stop HRT + OCP pre-op

Question 5

Wells score PE

Answer 5

3 Leg pain + pain on deep palpation

1. 5 HR>100
2. 5 Bed ridden >3d, major surgery <4wks
3. 5 Previous DVT/PE

1 Haemoptysis
1 Cancer Rx in last 6/12

3 Alternative diagnosis less likely than PE

Question 6

Wells score PE interpretation

Answer 6

<4 PE unlikely

>4 PE likely

Question 7

PE emergency management

Answer 7

Oxygen 10-15L/min if hypoxic
Morphine 5-10mg IV with emetic if pain
Start LMWH/fondaparinux
IV 500ml bolus if BP drop

If haemodynamically stable vasopressors (dobutamine 2.5-10µg/kg/min IV), aim for systolic >90
If haemodynamically unstable consider thrombolysis (alteplase 10mg IV bolus then IVI 90mg/2h)

Question 8

PE management post emergency treatment

Answer 8

Long term anti-coagulation

3mths if obvious cause, 6 if not