PH and PE Flashcards
Clinical presentation of a large PE
Cardiovascular shock
Low BP
Sudden death
central cyanosis
Clinical presentation of a medium PE
pleuritic pain
haemoptysis
breathlessness
Clinical presentation of a small, recurrent PE
dysnopea
PH
right heart failure
what kind of DVT is most likely to embolise
proximal
Risk factors of DVT
Trauma Contraceptive Thrombophilia Obesity Vasculitis Immobility Surgery Malignancy PH pregnancy
how is DVT prevented post op
low molecular weight heparin compression stockings mobilisation early post op rivaroxaban calf muscle exercise
what would ABG look like for someone with PE
decreased sats and PO2 but normal or low PCO2 - perfusion issue
how would CXR look with PE
maybe normal early on, atelectasis, consolidation, pleural effusion
geneva and wells score predict….
likelihood of developing PE
in PE D-dimer would be…
elevated
what is V/Q scan good for
small emboli in ambulatory patient - low risk
what is CTPA good for
central, large clots - ambulatory at low risk or high risk
how would DVT be diagnosed in pregnant woman
doppler, if unwell with suspected PE accept radiation risk and CTPA
what is PESI score used for
how likely a patient is to die of PE
you are waiting on test result for PE, do you start treatment?
start empirical treatment if high clinical suspicion
if deemed low risk wait for test result
what can you use pharmaceutically to treat PE?
LMWH - subcutaneous 1 daily
Rixaroxaban/apixaban/warfarin
tenecteplase - life threatening
what would you prescribe an IV drug user or cancer patient for PE
LMWH - fragmin
Rivaroxaban/warfarin do not work
how long do you treat unprovoked 1st PE for
6m
how long to treat provoked PE
3m
how long to treat low risk distal DVT
3m
how long to treat high risk, proximal DVT
6m
how long to treat recurrent PE
life long
true/false - young men usually considered for life long treatment
true
when would you remove someone from anticoagulants
when low risk (look at dash and herdoo2 score)
what should mPAP be normally
12-20 mmHg
how high is mPAP in a person with PH
over 25 mmHg
how can PH be diagnosed
ECHO doppler
right heart catheter
most common cause of PH
left heart disease
pulmonary oedema causes a ____ pattern of lung disease
restrictive
what causes pulmonary oedema
cardiac failure
ARDS
pneumonia
cell injury
where do thrombi form in DVT
valve pockets
true/false - VTE more likely to occur in those with provoked VTE
false- more likely to occur in unprovoked VTE
gold standard of diagnosing DVT?
Doppler
gold standard of diagnosing PE
CTPA
symptoms of post thrombotic disorder
Pain Oedema Hyperpigmentation Eczema Varicose veins venous ulceration
