PE case Flashcards

1
Q

What are the risk factors for PE

What can cause it

A
DVT, currently or previously
Immobilisation
Malignancy
Coagulopathy
Oral contraceptives
Venous thrombus
Tumour
Fat
Amniotic fluid
Air
Injected material
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2
Q

What are the signs and symptoms for PE

A

Pleuritic chest pain

-sharp, localized, worse on inspiration

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3
Q

What are the differentials for acute pleuritic pain

What are the differentials for slow onset pleuritic pain

A

Acute

  • PT
  • PE

Slow onset

  • Pneumonia
  • Cancer
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4
Q

What investigations would you order

What could you find

A

ECG (acute pulmonary HTN)

  • sinus tachycardia
  • RBBB
  • R ventricular strain (T wave inversion in V1-4)
  • Right axis deviation
  • Dominant R wave in V1 (RV dilation)
  • R atrial enlargement
  • S1Q3T3
  • tachyarrythmias
  • non specific ST changes

CXR

  • normal, rule out PT
  • can find other features
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5
Q

How would you interpret the results of the Wells score

How would you manage from here on

A

Less than 4

  • PE unlikely, D dimer
  • if still likely, offer CTPA and interim DOAC (apixaban, rivaroxaban)

More than 4

  • PE likely
  • Offer CTPA and interim anticoagulation

Fibrinolytic for PE (alteplase)

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6
Q

What are the 2 complications of PE

A

Hypoxia
-VQ mismatch

RV failure
-pulmonary circulation normally has a large reserve => but if it all fills up, puts pressure on RV => CV collapse, cardiac arrest

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7
Q

What are the questions that you would ask in the Wells score

How would you score each of the 7 questions

A
Signs and symptoms of DVT = 3
Alternative diagnosis unlikely = 3
Tachycardia (100+) = 1.5
Immobilized for 3+ days/surgery in past month = 1.5
Past DVT/PE = 1.5
Haemoptysis = 1
Malignancy in the last 6 months = 1
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8
Q

How would you manage post discharge

A

Provoked VTE => 3months on DOAC

Unprovoked VTE => 6months on DOAC

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