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Respiratory > Pulmonary embolism > Flashcards

Pulmonary embolism Flashcards

1
Q

Define pulmonary embolism

A

Occlusion of pulmonary vessels, most commonly by a thrombus that has travelled to the pulmonary vascular system from another site

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2
Q

Aetiology of pulmonary embolism

3

A

Thrombus
95% arise from DVT in lower limbs
Rarely arises in right atrium (in AF patients)

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3
Q

Other causes of thrombus

5

A 
Amniotic fluid
Air
Fat
Tumour
Mycotic
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4
Q

Risk factors for pulmonary embolism

6

A 
Surgical patients
Immobility
Obesity
OCP
Heart failure
Malignancy
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5
Q

Epidemiology of pulmonary embolism

prevalence + DVT

A

Relatively COMMON

Occur in 10-20% patients w/ confirmed proximal DVT

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6
Q

Presenting symptoms of pulmonary embolism

general + 4types of PE

A

Depends on SITE & SIZE of embolus

Small
Moderate
Large
Multiple small recurrent

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7
Q

Presenting symptoms of pulmonary embolism - small

A

May be ASYMPTOMATIC

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8
Q

Presenting symptoms of pulmonary embolism - moderate

4

A

Sudden onset SOB
Cough
Haemoptysis
Pleuritic chest pain

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9
Q

Presenting symptoms of pulmonary embolism - large

6

A 
As above +
Severe central pleuritic chest pain
Shock
Collapse
Acute right heart failure
Sudden death
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10
Q

Presenting symptoms of pulmonary embolism - multiple small recurrent

A

Symptoms of pulmonary hypertension

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11
Q

Signs of pulmonary embolism on physical examination

general

A

Severity of PE can be assessed based on associated signs

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12
Q

Signs of pulmonary embolism on physical examination - small

2

A

Often no clinical signs

May be some tachycardia & tachypnoea

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13
Q

Signs of pulmonary embolism on physical examination - moderate
(4)

A

Tachypnoea
Tachycardia
Pleural rub
Low O2 saturation (despite O2 supplementation)

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14
Q

Signs of pulmonary embolism on physical examination - massive
(3)

A 
Shock
Cyanosis
Signs of right heart strain
- raised JVP
- left parasternal heave
- accentuated S2 heart sound
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15
Q

Signs of pulmonary embolism on physical examination - multiple recurrent
(2)

A

Signs of pulmonary hypertension

Signs of right heart failure

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16
Q

Investigations for pulmonary embolism

9 types

A 
Well’s score
Bloods
ECG
CXR
Spiral CT pulmonary angiogram 
Ventilation-perfusion (VQ) scan
Pulmonary angiography
Doppler US of lower limb
Echocardiography
17
Q

Investigations for pulmonary embolism - Well’s score

3

A

Used to determine the best investigation for PE

Low probability (Wells 4 or less) - use D-dimer
High probability (Wells >4) - requires imaging (CTPA)
18
Q

Investigations for pulmonary embolism - bloods

2

A

ABG

Thrombophilia screen

19
Q

Investigations for pulmonary embolism - ECG

3

A

May be normal
May show tachycardia, right axis deviation or RBBB
May show S1Q3T3 pattern

20
Q

Investigations for pulmonary embolism - CXR

A

Often NORMAL but helps exclude other diagnoses

21
Q

Investigations for pulmonary embolism - spiral CT pulmonary angiogram
(3)

A

1ST LINE INVESTIGATION
Poor sensitivity for small emboli
Very sensitive for medium to large emboli

22
Q

Investigations for pulmonary embolism - VQ scan

A

Identifies areas of ventilation & perfusion mismatch —> indicates area of infarcted lung

23
Q

Investigations for pulmonary embolism - pulmonary angiography
(2)

A

Invasive

Rarely necessary

24
Q

Investigations for pulmonary embolism - doppler US of lower limb

A

Allows assessment of venous thromboembolism

25
Q

Investigations for pulmonary embolism - echocardiography

A

May show right heart strain

26
Q

Management of pulmonary embolism

4 groups

A

Primary prevention
Haemodynamically stable
Haemodynamically unstable
Surgical or radiological

27
Q

Management of pulmonary embolism - primary prevention

3

A

Compression stockings
Heparin prophylaxis for those at risk
Good mobilisation & adequate hydration

28
Q

Management of pulmonary embolism - haemodynamically stable

4

A 
O2
Anticoagulation w/ heparin or LMWH
Switch to oral warfarin for at least 3 months
- maintain INR 2-3
Analgesia
29
Q

Management of pulmonary embolism - haemodynamically unstable
(4)

A 
(massive PE)
Resuscitate
O2
IV fluids
Thrombolysis w/ tPA may be considered if cardiac arrest is imminent
30
Q

Management of pulmonary embolism - surgical or radiological

2

A

Embolectomy
IVC filters - sometimes used for recurrent PEs despite adequate anticoagulation or when anticoagulation is contraindicated

31
Q

Complications of pulmonary embolism

4

A

Death
Pulmonary infarction
Pulmonary hypertension
Right heart failure

32
Q

Prognosis of pulmonary embolism

3

A

30% mortality in those left untreated
8% mortality w/ treatment
Increased risk of future thromboembolic disease

Respiratory (14 decks)

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