PE/DVT - Hubbard and Slocum

Question 1

95% originate from

Answer 1

DVT in leg veins, most commonly the proximal deep veins of lower extremities

Question 2

Pts classically charaacterzed as

Answer 2

• pregnant/postpartum
• oral contraceptive users
• smokers
• long distance travellers

Question 3

PE leads to

Answer 3

• pulm infarcts
• Right sided HF
• hypoxia

Question 4

Risk factors included Virchow’s triad. give examples of each of the triads

Answer 4

Stasis: immobility, CHF, obesity, surgery, long flights or car rise

Endothelial damage: trauma; fracture, previous DVT

Hypercoagulable states: pregnancy, OCP, protein C/S deficiency, factor V leiden, severe burns, cancer, essential thrombocythemia

Question 5

Signs and symptoms

Answer 5

• sudden onset dyspnea
• pleuritic chest pain
• low grade fever
• cough
• anxiety
• hemoptysis

Question 6

Physical exam findings

Answer 6

• tacypnea
• tachycardia
• hypoxia and hypocarbia
• erythemaotus, swollen, warm, lower extremity
• positive Homan’s sign

Question 7

Diagnostic criteria:

Answer 7

PERC criteria: if none present, rules out DVT/PE in outpatient setting:
- Age> 50
- pulse >99/min
O2 sat <95%
Personal history of VTE
-Trauma/surgery within 4 weeks
-Estrogen intake
- unilateral leg swelling
-hemoptysis

Question 8

Chest radiograph findings

Answer 8

• usually normal
• may show pleural effusion
• Hampton’s hump, wedge-shaped infarct
• Westermark’s sign, oligemia in embolized lung zone

Question 9

EKG findings

Answer 9

non diagnostic, but may show sinus tach, right heart strain as class triad: S wave in lead I; Q wave in lead III, T wave inversion in lead III; new onset RBBB

Question 10

ABG findings

Answer 10

• respiratory alklosis (O2<80 mmHg; CO2 <40 mmHg);

A-a gradient elevated

Question 11

Confirmatory tests

Answer 11

• D-dimer (not specific, use it to rule out PE)
• V/Q scan (use if chest radiograph is normal, if normal rule out PE, if indeterminate then test for DVT, if DVT is normal then proceed to CT angiography
• Pulm angiogram: diagnostic gold standard, more invasive and rarely performed - highest mortality
• CT angiogram: use if chest radiograph is abnormal, sensitive for saddle PE
• Venous US of LE

Question 12

Treatment

Answer 12

• Anticoagulate: heparin followed by LWMH Sq; warfarin for long term anticoagulation
• Thrombolysis: only indicated in severe cases such as massive DVT, PE causing RHF