Prognosis case - PE Flashcards
Sudden onset dyspnea after surgery
PE, ACS
Low probability of PE, what to order?
D-dimer test
What you see on CT PE?
direct visualization of the embolus, presence of intraluminal filling defects, the vessel cutoff sign (indicating complete occlusion), and infarction of the lung
If low risk for PE, what imaging can be done (also reduces radiation to patient)?
DVT US
Renal failure, allergy to contrast, what imaging?
VQ scan
Chest x-ray PE
pulmonary infarction like the presence of a wedge-shaped opacity in the periphery of the lung (Hampton Hump) or decreased vascularity (Westermark sign)
If unstable, so CTPE cannot be done… can do
TEE instead
See emboli in pulmonary arteries, RV dysfunction/overload
What does hemodynamic instability look like in PE
Shock
Hypotension
If high risk of adverse outcome i.e. unstable, can do…
Embolectomy
Thrombolysis
If stable… can do
Echo - myocardial dysfunction,
Trops - myocardial injury
Both should go to ICU
Anticoagulation of PE… options
LMWH
Unfractionated heparin (enoxaparin, tinzaparin)
Fondaparinux
Vitamin K antagonist (warfarin) - INR target 2-3
Hemodynamically unstable… treatment?
Thrombolysis - TPA, alteplase
Mechanical embolectomy
If contraindication to coagulation.. use?
IVC filter
