Pulmonary Emboli Flashcards
a blockage within the pulmonary circulation
pulmonary embolism
what is the most common etiology of a pulmonary embolism?
DVT
in what location is there a higher likelihood of embolization of a pulmonary embolism?
popliteal space
what is the homan sign for DTV?
swollen, warm, painful calf
dorsiflex of ankle hurts the calf
what are 3 factors that contribute to thrombosis? (VIrchow Triad)
- venous stasis
- injury to vessel wall
- hypercoagulability
a patient presents with sharp, stabbing chest pain or back pain, tachypnea, tachycardia, decreased O2 sat, increased body temperature, anxiety, dyspnea, and evidence of DTV. what are they likely experiencing?
pulmonary embolism
what diagnostics should I order for a patient with suspected PE? (5)
EKG
Chest Xray
Pulmonary angiography
V/Q scan
Venous Doppler US
what would be seen in a patient’s EKG if they have a PE?
right heart strain
why would I want to order a chest xray in a patient with suspected PE?
rule out other causes
what is the gold standard imaging for a patient with suspected PE?
pulmonary angiography
what will be seen in a patient’s pulmonary angiography if they have a PE?
filling defect
what imaging would be best for a pregnant patient or a patient that is allergic to contrast, with suspected PE?
V/Q scan
why would I want to use a venous doppler US in a patient suspected with PE?
look for DTV
after reviewing Wells Criteria, at what point should I look at PERC for possible D-dimer?
Wells less than or equal to 4
after reviewing Wells Criteria, at what point would imaging be needed?
Wells more than 4
what would I need to do if a patient has at least one positive answer for PERC?
evaluate with D-dimer
what should I give a patient with a PE that is thrombotic?
heparin or LMWH
what should I give a patient that is D/C’d with low bleeding risk?
oral warfarin + LMWH
what should I give a patient that is D/C’d with low bleeding risk, that would not require a bridge?
rivaroxaban
what should I give a patient that is D/C’d with high bleeding risk?
IVC filter
what can I give to a patient on heparin, LMWH, or warfarin to reverse effects of those medications?
vitamin K
how long should a patient be treated if this is their first PE and we know the transient etiology?
3 months
how long should a patient be treated if this is their 1st or recurrent PE without known etiology OR their 1st PE due to malignancy?
indefinite
