Pulmonary Emboli

Question 1

Pathophysiology

Answer 1

Detached intravascular mass carried to lungs by blood

Question 2

Cause

Answer 2

DVT

Question 3

Risk factors

Answer 3

Abnormal blood flow
Hypercoaguable blood (post MI, cancer treatment)
recent surgery

Question 4

Investigations

Answer 4

1st - CTPA or V/Q scan (if renal issues present)
ECG
D-dimer
chest X-ray

Question 5

What would be present on the ECG?

Answer 5

Acute R strain

Question 6

What would the d-dimer test show?

Answer 6

Raised D-dimers

Question 7

Treatment

Answer 7

LMW heparin or fondaparinux for 5 days or until INR>20 for 24hrs
Warfarin for 3 months or other Vitamin K antagonist

Question 8

Treatment (large PE)

Answer 8

Thrombolysis if haemodynamically unstable

Question 9

What is associated with a large PE?

Answer 9

Circulatory failure (e.g hypotension)

Question 10

What is associated with PE

Answer 10

Pleural effusion

Question 11

Describe a pleural effusion that accompanies a PE

Answer 11

small and blood stained

Question 12

Patients with PE may enter what?

Answer 12

Respiratory alkalosis

Question 13

Symptoms

Answer 13

severe chest pain
dyspnoea
haemoptysis

Question 14

what investigation would be used in a pregnant patient with suspected PE

Answer 14

V/Q scan

Question 15

a well’s score of what makes PE unlikely

Answer 15

< or = 4

Question 16

a well’s score of what makes PE likely

Answer 16

> 4

Question 17

when would IVC filter be offered

Answer 17

if PE remains despite anticoagulation after considering increasing LMWH