Pulmonary Embolism Flashcards
define pulmonary embolism?
blocking material in lung vessel
define embolism etymologically?
emballein (greek) = insert
from femoral vein how does a dvt clot get to the pulmonary vasculature?
list the venous pathway.
femoral vein, external iliac vein, common iliac vein, IVC, SVC, RA, RV, pulmonary artery, small pulmonary vasculature
what is a big blockage called?
Massive PE
what can a Massive PE lead to in terms of heart?
and how?
cardiac arrest
Massive PE –> pulmonary HTN –> RV strained –> cor pulmonale –> cardiac arrest
what is pulmonary infarction?
lung tissue dead from ischaemia
which triad explain risk factors for PE?
Virchow’s triad
cor pulmonale causes what to happen to RV size?
RV hypertrophy
pt has cor pulmonale, what might you see around neck?
why?
↑JVP
backlog of venous pressure
define provoked DVT?
transient RF present in last 3 months
define unprovoked DVT?
no transient RF present in last 3 months
pt has unprovoked DVT.
what must be on your differential radar because of this that you need to investigate?
what Ix do you use to investigate this?
-2
thrombophilia
Antiphospholipid antibodies + Thrombophilia screen
what is best sign to check if massive PE on pt’s vital?
hypotension
pt has suspected PE and seems likely based on Hx.
CXR has been done.
what Ix do you do now?
CTPA
pt has suspected PE and positive D dimer.
what Ix do you do now?
CTPA
Pt might have PE based on history but is unlikely.
CXR normal.
what Ix do you do now to check if it is PE?
D-dimer
red flag symptoms or PE?
-1
Syncope
symptoms of PE?
Pleuritic chest pain Dyspnoea Cough Haemoptysis Fever
news chart results of pt with PE?
-4
↑RR
↑HR
↓O2
low BP
if there is DVT what sign will you see on examination?
Red swollen calf
if there is right ventricular strain what sign will you see on examination?
Right parasternal heave
there are usually chest sounds if pt has PE.
true or false?
false
two main IX for PE?
D-dimer
CTPA
pt has PE history.
on ECG there is RBBB + right axis deviation.
what is this a sign of?
RV strain
symptoms of PE?
Pleuritic chest pain Dyspnoea Cough Haemoptysis Fever
Massive PE Mx?
Thrombolysis
standard PE Mx?
how long for?
anticoagulation 3 months
what drug do you use in thrombolysis?
if Thrombolysis failed what is your 2nd option?
alteplase
surgical embolectomy
when is thrombolysis the first line Mx?
Massive PE
MX for refractory PE?
IVC filter
pt has PE,
it is not massive PE.
what is standard Mx?
how long for?
anticoagulation 3 months
Which anticoagulant do you use in PE 1st line?
- give named e.g.
what group of drugs do these drugs belong to
moa of these drugs?
APIXABAN AND RIVAROXABAN
DOAC
factor X inhibitors
Which anticoagulant do you use in PE if there is renal impairment?
LMWH
Heparin side effect?
-1
thrombocytopaenia
