Pte Flashcards
Pesi
11 variables
5 xlasses
Leds than 65- class 1 - 1%mortality
Class 5 - 125- 25 percent mortality
Simplified pesi
Variables
Interpretation
Age 80
Cancer
Chronic cardiopulmonary disease
Hr 110.
BP 100
Pao2 90
0 - no risk
>1 - high risk
Non thrombotic
Fat
Air
Amniotic
Tumor
Sources of embolism
Dvt
Pelvic.
Right ventricle
Renal and uterine vein
Sickle cell
Virchows triad
Hypercoagulability
Stasis
Injury
Risk factors
Immobility
Major surgery
Apla
Hyper coagulation states- malignancy, ocp, hit, essential thrombocytosis, pregamancy , protein c and s deficiency
Pathophysiology
Pulmonary vascular bed obstruction
Increased rv afterload- dilattaion- dec contractility- output dec- lv input dec- co dec- bpdec- coronary perfusion dec- o2 deliver- shock- death
Clinical prediction scores
Wells
Original geneva
Geneva
Pisa rule
Charlotte rule
Wells cps
7 variables
Dvt symptoms3
Prior dvt/pe.1.5
Malignancy1
H/o immobilization surgery 4 wks1.5
Hr 100. 1.5
Hemoptysis 1
Alternate diagnosis less likely 3
6 - high
Ecg pe
S1q3t3
Mc- tachy
Right strain pattern
Tall peaked t wavright axis deviation
Rbb
Cxr
D-dimer fp
Westermark
Hanptons hump
Pallas
Fp- pregnant, malignant, ami, sepsis,hepatic
Age >50 -
Angio
Cutoff sign
Intraluminal filling defect
Polo mint sign
Other tests
Vq scan
Pulm angio
2d echo- 60-60 sign,mcconnel sign
Doppler
Algorithm in shock
Ct available- do- pos-treat
Neg- search for other
Not available
Then echo- if no rv load- search
If plus- no other test available- rx
Algorithm without shock
Assess probability clinically
Low/int or unlikely- d-dimer
Neg- no rx
Pos- ct angio and accordingly
Hogh/likely- angio
Advantage sof ufh
Renal failure
Obesity
Monitoring easy
Pregnancy
Pt awaited for surgery
Lmwh advantages
Longer half life
Early
No need of monitoring
Less complications
Tx
Acute- lmwh/ufh/fondaparinux for 5-10 days
Overlap with warfarin or dabigatran or edoxaban- asap
UfhZ- 80/kg f/b 18/kg/hr infusion
Inr 1.5- 2.5
Dose of warfarin
10mg in younger , healthy op
5mg in old , hospitalized
Dialy inr
Inr2-3
Side effects- skin necrosis, protein c def
Oral xa inhibitors
Xaban
Direct thrombin inhibitor
Dabigatran,lepirudin
Lysis indications
Masive pe
BP <90 for 15 min
C/i- hmg7c stroke
Ischemic stroke - 6mon
Cns damage
trauma ,surgery in 3 wks
Git bleeding one month
High bleeding risk
Agents for lysis
Streptokinase- 2.5 l f/b 1lakh over 12-24 hrs
Urokinase- 4400iu/kg loading 10 min f/b per hourc12-24 hrs
Rtpa- 100mg 2hr
Duration
Reversible - 3 mon
Unprovoken- indefinite
Recurrent- indefinite
Other
Interventional- causes fragments- paradoxical embolism- in pts where thrombolyis c/I
Filter- same indication and where ac is c/i
Prophylaxis
Active leg movt
Pneumatuc compressions
Elastic compression
Ac
