PE overview

Question 1

DVT

Answer 1

Limits the return of blood through the venous system and back to the heart. Blood will back of blood to toward the capillary bed and be forced into tissue leading to edema. Seen in Lower extremities

Question 2

Virchow’s triad- 3 things leading to the development of DVT

Answer 2

1. Circulatory stasis- where blood sits it has tendency to clot
2. Hyper-coagulability- use of contraceptives, clotting much easier
3. Endothelial injury- like drawing blood or giving an IV. Plaque build up can cause endothelial injury

Question 3

After the DVT forms it’s going to go into coronary circulation and lead to issues like:

Answer 3

Vasoconstriction- lack of o2

Less surfactant production

Inflammatory response

Pulmonary edema

Question 4

General manifestations

Answer 4

Dyspnea
Chest pain
Decreased o2 sat, CO
Systemic hypotension and shock

Question 5

Clinical manifestations

Answer 5

Include general 
Clear or wheezing lung sounds 
Diminished lung sounds where blockage is
Hyperventilation 
Sweating 
Lightheadedness, fainting 
Weak pulse 
Rapid/ irregular heart beat

Question 6

Large emboli

Answer 6

increased chest pain with coughing or deep breathing; tachypnea and dyspnea develop suddenly
–Later: hemoptysis and fever
–Hypoxia: causes anxiety, restlessness, pallor, tachycardia

Question 7

Massive emboli

Answer 7

Medical emergency

Severe crushing chest pain
low blood pressure
rapid weak pulse
loss of consciousness

Question 8

Diagnosis

Answer 8

Hx physical (wells score)
Blood tests (D-dimer, complete blood count, clotting studies)
•Imaging
–Pulmonary angiography (gold standard)
–CT scan (non-invasive)
–V/Q scan (ventilation/perfusions scan)

Question 9

Treatment

Answer 9

Prevention best
Health teaching
–prior to surgery- ambulation
–Anti-embolic stockings
–Exercise to prevent thrombosis- walk on flight
–Use of anticoagulant drugs- heparin and warfarin
- acute- oxygen therapy, anesthesia

Question 10

Surgical interventions

Answer 10

–Inferior vena cava filter

–Pulmonary thrombectomy

Question 11

Pathophysiology

Answer 11

May originate in leg as DVT, then go through the RIGHT side of the heart and into pulmonary circulation