PE management

Question 1

Typical clinical presentation in mild PE

Answer 1

Can be painless with dyspnoea or syncope/pre-cyncope

Question 2

Investigations to diagnose PE

Answer 2

First line: CT pulmonary angiography

CXR, ECG
V/Q study
D-dimer assay
Arterial blood gasses

Question 3

Management of PE: Immediate then ongoing

Answer 3

Oxygen

Immediate LMWH IV: 5000 units immediate bolus
30,000 units over 24 hours

Adjust heparin from then on according to APTT

Continue heparin 5-10 days
Start warfarin after 3-4 days - continue heparin for 3 days till INR steady at 2-3

Question 4

Typical clinical presentation in serious-massive PEs

Answer 4

Sudden onset dyspnoea and pain - usually retrosternal
Syncope may accompany
Hypotension, Acute right heart failure, or even AMI can occur if massive

Question 5

Spontaneous pneumothorac typical presentation, including typical patients / patient hx

Answer 5

Typically in younger, slender males with no lung path hx- spontaneous
Hx asthma or emphysema (hallmarks)

Acute onset pleuritic pain
Dyspnoea

Question 6

How is spontaneous pneumothorax made?

Answer 6

EXPIRATORY CXR

Question 7

Overview of management guidelines based on size of pneumothorax and sx?

Answer 7

observe
drain
>25% collapse –> drain

Question 8

Acute tension pneumothorax management

Answer 8

Urgent cases –>
12-16 guage needle into pleural space through 2nd ICS of affected side
Replace with formal intercostal catheter connected to underwater seal drainage