Pulmanory Embolism

Question 1

Virchow triad in pulmanory embolism?

Answer 1

1.venous stasis
2.endothelial damage
3. Hypercoagulation

Question 2

Acquired Risk factors

Answer 2

Age>50, Previous DVT, PE, estrogen treatment, pregnancy, fracture,immobilization, malignacy ,burns,surgery,, obesity,,congestive HF,stroke, MI

Question 3

Genetic risk factors

Answer 3

Factor V leiden mutation
Antithrombin 3 deficiency
Protein C/ S deficiency
Prothrombin gene mut/prothrombin elevation
Antiphospholipid syndrome

Increased factor 8/9
Hereditary thrombophilia
Blood group other than 0
Hyperhomocystinemia

Question 4

Pulmanory embolism Symptoms

Answer 4

Acute dyspnea
Tachypnea
Chest discomfort/pain
Hemoptysis
Cyanosis
Shock/syncope
Dvt symptoms(swell,erythema,warming,pain, homans sign)

Question 5

Dgx of pulmanory embolism

Answer 5

Wells score
Chest radiology
Pulmanory angiography (G)
Venous doppler
D-dimer
Ventilation/perfusion scan
ABG analysis
Spiral CT/angiography
ECG
Echo

Question 6

Treatment for emboli

Answer 6

Anticoagulant(ufh,lmwh,warfarin, rivaroxaban) ~secondary prophylaxis
Supportive:o2, Fluid, vasopressors
Thrombolytics=for massive embolism~ primary reperfusion
Thrombectomy

Question 7

Radiology of PE

Answer 7

Hamptons hump (pulmanory infarct)/ wedge shaped
Fleischner sign( dilated central pulm artery)
Westermarks sign( decreased vascularization)
Plate atelectasis
Pleural effusion

Question 8

Heparin / UFH

Answer 8

Prophylactic for recurrences
Inhibits AT3
aPTT check every 6 hours (1,5-2,5 kat amaç)

Loading dose 80 U/kg, then 18 for kg/hr
Then warfarin 5mg first 24 hours, INR 2-2,5 heparin stopped
Side effects: hemorrhagia,thrombocytopenia,osteopenia,cutaneous rush
Contraindication: hemorhagia

UFH antidote: protamine sulphate
Warfarin antidote: vit K

Lmwh: enoxaparin,fondaparinux
Warfarin: factor 2,7,9,10 inhib.
Monitor pt,inr

Question 9

New oral anticogulants

Answer 9

Rivaroxaban: factor 10 inhibition,no antidote
Not in renal failure

Dabigatran:thrombin inh,no antidote
Not in pregnancy

General treatment average 6-12 months or lifelong for recurrent,irreversiblr
3-6 if reversible and <60

Question 10

Thrombolytics

Answer 10

In 14 days
Massive Pulmonary Embolism
• Hypotension
• Deep hypoksemia
• Right ventricular disfunction/iskemia
• Cardiovascular collaps

rt-PA: 2 hours,100 mg

Question 11

Prophylaxis for emboli- 2/4 weeks after surgery

Answer 11

Lmwh( safe preop)
Rivaroxaban 10 mg
Compression stockings
Pneumatic compression
Foot impulse pumps