PE, PTx, Pleural Effusion Flashcards
1
Q
PE
diagnostic tools
A
- Wells Score
- 1Wells Negative then rule out with PERC
- PERC normal then nil further
- 3 PERC positive then D dimer to rule out
- Wells Positive then imaging
2
Q
Most common sx of PE
A
dyspnoea
chest pain
sx of DVT
hemoptysis - rare
3
Q
Mx DVT
A
distal –> 15% extension, treat for 6/52
prox - treat for 3/12
4
Q
PE mx
A
Cleaxane 24-48/42
NOAC
Shock - alteplase
5
Q
PE risk factors
A
previous VTE active cancer unprovoked VTE in the last 3/12 male PROX DVT Thrombophilias
6
Q
Ptx Classification and Clinical Severity Classification
A
Primary - no underlying lung dx. Secondary - ?COPD, ILD etc
Clinically
- size (<2cm or more)
- symptoms
- stable or not
7
Q
PTx management
A
Clincally stable, <2cm –> home with repeat CXR
Small but unstable or large but stable –> aspiration. unsuccessful asp –> ICC
8
Q
Ptx safe to fly - time
A
2/52
9
Q
Ptx - recurrence rate and factors
A
30-50% recurrence. Recommend pleurodesis after first recurrence
RF - smoker
10
Q
Lights criteria
A
- Pleural fluid Protein /Serum Protein ratio >0.5
- Pleural Fluid LDH /Serum LDH ratio >0.6
- Pleural Fluid LDH > 2/3 upper limit normal serum level
11
Q
pleural fluid - other biomarkers
A
CRP - infection BNP - Heart failure ADA (adenosine deaminase) - TB. If very elevated then empyema or lymphoma Cytology (40% will be missed) Pleural elastase - trapped lung
12
Q
Mx of empyema
A
Drain
MIST2 Trial - add DNAse to tPA
