Pulmonary Circulation Flashcards
Thrombus in pulmonary artery or branches. Not a disease itself but a cause of DVT.
Pulmonary embolism
95% of PE’s arise from?
Lower extremities/pelvic DVT
What is virchow’s triad?
Stasis, hypercoagulability, intimal damage
What is the most common symptoms of a PE?
Dyspnea
What is the most common sign of a PE?
Tachypnea
What is the classic triad that a patient will give you in a history that should clue you in to a PE?
Dyspnea
Pleuritic chest pain
Hemoptysis
Post-op patient with sudden tachypnea, tachycardic, apprehensive and complaining of pleuritic chest pain, with hemoptysis and cough
Classic presentation of a patient with a PE
If there is a massive PE, what will the symptoms be?
Syncope, hypotension, pulseless electrical activity
What is a predisposing condition to a PE?
Factor V Leiden
____% of patients with a DVT will have a PE
50
Is the PE on a patient with a pulmonary embolism usually normal?
Yes! Could have rales or pleural friction rub, but usually unremarkable
What special test may be positive on a patient with a PE?
Homan’s sign test (Calf pain with dorsiflexion)
What does the CXR NORMALLY look like on a patient with a PE?
Normal! If you have a normal CXR in a setting of highly suspicious hypoxia, be suspicious!
Pleural effusion and atelectasis are two things that could be seen on a CXR on a patient with ___ ___
Pulmonary embolism
Okay, I gave that one to you
What are the classic, but less common, signs of a PE?
Westermark’s sign
Hamptom’s Hump
Abrupt cut off vessels
Avascular markings distal to area of embolus
Westermarks’ sign
Wedge-shaped infiltrate
Hampton’s hump
What are the most common ECG findings on a patient with a PE?
Sinus tachycardia with nonstop ST/T changes
What will the ABG on a patient with a PE be initially?
Respiratory alkalosis
What will the ABG on a patient with a PE be over time?
Respiratory acidosis; increase in A-a gradient
Is a D dimer useful in diagnosing a PE?
It is helpful if it is negative but nonspecific if it is positive
What is the gold standard to diagnose a PE?
Pulmonary angiography (usually only done if high suspicion and negative CT or VQ scan)
What is the initial screening test for a PE?
Helical CT scan
Why should you use a doppler ultrasound to help diagnose a PE?
70% of patients with PE have + lower extremity (DVT)
If veins are non compressible on ultrasound, what does that mean?
+ for DVT
If you have a patient with a PE and they are hemodynamically stable, what are your two options?
UFH or LMWH and PO warfarin
OR
IVC filter if anticoagulation contraindicated
If you have a patient with a PE and they are hemodynamically Unstable, what are your two options?
Thrombolytic tx
OR
Embolectomy if anticoagulation contracindicated
Why do you treat PEs with heparin?
To prevent further emboli rather than treat the existing one
Is the first PE usually the most deadly?
No, usually the first episode doesn’t kill, subsequent PEs are more deadly
What do you have to monitor when dosing unfractioned heparin?
PTT
If you give LMWH, do you have to monitor PTT?
No
How long should a patient be on warfarin for an initial DVT?
3-6 months
What pathway does warfarin work with?
Extrinsic II, VII, IX, X, protein C and S
What is the antidote for heparin toxicity?
Protamine sulfate
What can you use for thrombolysis of a clot?
Altepase (tPA), streptokinase, urokinase
When should you use altepase, or another thromolysis drug on a patient with a PE?
For a massive PE or hemodynamic compromise in which anticoagulation is contraindicated
When is thrombolysis contraindicated?
Internal bleed or CVA w/in 2 months
When should you perform a thrombectomy or embolectomy?
Massive/unstable PE or if thrombolysis is ineffective
What ist he most important step in managing a PE?
Prophylaxis!
Who is prophylaxis warranted in?
Pre op in patients undergoing surgery with prolonged immobilization, pregnant women, or history of prior DVT/PE
What are some non-invasive ways to help your patients prevent blood clots
Ambulation, elastic stockings, pneumatic compression devices/venodyne boots
I used to have to do all of these with my patients and putting TED stockings on is a fate worse than death.
What is the third leading cause of death in hospitalized patients?
PE.. but you never could’ve guessed that
What heart sound will be accentuated in a patient with a PE?
The second sound (S2)
What ECG pattern is classic for a PE, and shows cor pulmonae?
S1Q3T3
What are the three most common places to get a DVT
Iliofemoral vein
Popliteal vein
Pelvic vein
