Pulmonary Emboli

Question 1

a blockage within the pulmonary circulation

Answer 1

pulmonary embolism

Question 2

what is the most common etiology of a pulmonary embolism?

Answer 2

DVT

Question 3

in what location is there a higher likelihood of embolization of a pulmonary embolism?

Answer 3

popliteal space

Question 4

what is the homan sign for DTV?

Answer 4

swollen, warm, painful calf
dorsiflex of ankle hurts the calf

Question 5

what are 3 factors that contribute to thrombosis? (VIrchow Triad)

Answer 5

1. venous stasis
2. injury to vessel wall
3. hypercoagulability

Question 6

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?

Answer 6

pulmonary embolism

Question 7

what diagnostics should I order for a patient with suspected PE? (5)

Answer 7

EKG
Chest Xray
Pulmonary angiography
V/Q scan
Venous Doppler US

Question 8

what would be seen in a patient’s EKG if they have a PE?

Answer 8

right heart strain

Question 9

why would I want to order a chest xray in a patient with suspected PE?

Answer 9

rule out other causes

Question 10

what is the gold standard imaging for a patient with suspected PE?

Answer 10

pulmonary angiography

Question 11

what will be seen in a patient’s pulmonary angiography if they have a PE?

Answer 11

filling defect

Question 12

what imaging would be best for a pregnant patient or a patient that is allergic to contrast, with suspected PE?

Answer 12

V/Q scan

Question 13

why would I want to use a venous doppler US in a patient suspected with PE?

Answer 13

look for DTV

Question 14

after reviewing Wells Criteria, at what point should I look at PERC for possible D-dimer?

Answer 14

Wells less than or equal to 4

Question 15

after reviewing Wells Criteria, at what point would imaging be needed?

Answer 15

Wells more than 4

Question 16

what would I need to do if a patient has at least one positive answer for PERC?

Answer 16

evaluate with D-dimer

Question 17

what should I give a patient with a PE that is thrombotic?

Answer 17

heparin or LMWH

Question 18

what should I give a patient that is D/C’d with low bleeding risk?

Answer 18

oral warfarin + LMWH

Question 19

what should I give a patient that is D/C’d with low bleeding risk, that would not require a bridge?

Answer 19

rivaroxaban

Question 20

what should I give a patient that is D/C’d with high bleeding risk?

Answer 20

IVC filter

Question 21

what can I give to a patient on heparin, LMWH, or warfarin to reverse effects of those medications?

Answer 21

vitamin K

Question 22

how long should a patient be treated if this is their first PE and we know the transient etiology?

Answer 22

3 months

Question 23

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?

Answer 23

indefinite