PE + pulmonary blood flow Flashcards
What is a pulmonary embolism?
obstruction in pulmonary arterial tree
What is virchow’s triad?
Vessel wall damage
Venous stasis
Hypercoagulability
Risk factors for DVT
Surgery+reduced mobility Pregnancy Malignancy HRT/contraceptive pill Long distance sedentary travel
Symptoms of PE?
Dyspnoea, pleuritic chest pain, cough, haemoptysis, syncope, DVT, tachypnoea, tachycardia,
How does the heart sound in PE?
Gallop - widely split second heart sound
Signs of PE?
Raised JVP
Pleural rub
Hypotension
What do you do if you suspect PE?
Calculate WELLS score
What is WELLS score
Assessment of the clinical probability of venous thromboembolism
A WELLS score <4
D-dimer
A WELLS score >4
CTPA
Who can’t have CTPA? what do they get instead?
Kidney failure or contrast allergy, V/Q spect
Unprovoked PE?
Malignancy - do physical examination, CXR, blood tests, urinalysis
ECG in PE?
S1, Q3, T3 - deep S waves, Q waves and inverted T waves
Initial resuscitation for PE?
Oxygen IV access Analgesia LMWH If unstable or massive PE give alteplase
Who can’t have LMWH?
Renal impairment
Increased bleeding risk or harm-dynamically unstable
Continued PE management?
Anti-coagulate for 3 months - longer for unprovoked PE
What is a massive pulmonary embolism?
Clinically compromised - large clot burden, elevated lactate, BNP and troponin, haemodynamically unstable
What is a pleural effusion?
Excess fluid in pleural space
Difference between exudative and transudative?
Exudative protein rich + LDH rich
Transudative not
Causes of exudative pleural effusion?
Pneumonia Malignancy Tuberculosis Pulmonary infarction (massive PE) Autoimmune disease Pancreatitis Yellow nail syndrome Drugs
Causes of transudative pleural effusion?
Left ventricular failure Hepatic failure Nephrotic syndrome Peritoneal dialysis Hypoalbuminemia Pulmonary embolism Hypothyroidism Ovarian hyperstimulation Constrictive pericarditis SVC obstruction
Criteria for exudative effusion?
Pleural protein:serum protein >0.5
Pleural LDH:serum LDH >0.6
Signs of pleural effusion?
Absent breath sounds
Dull to percussion
Decreased tactile fremitus
Decreased vocal resonance
