Pulmonary embolism Flashcards
Three risk factors for PE?
Immobility Recent surgery Pregnancy Hormone therapy with oestrogen Malignancy SLE Prev hx DVT/PE
What is the prophylactic management of VTE?
LMWH e.g. enoxaparin
Two contraindications to VTE prophylaxis?
active bleeding
existing anticoag e.g. warfarin or NOAC
Three symptoms of PE?
dyspnoea
pleuritic chest pain
haemoptysis
syncope
Three signs of PE?
Tachyopnoea Fever Cyanosis Tachycardia Hypotension Evidence of DVT
Which scoring system is used in PE?
Well’s score
What is the function of Well’s score?
predicts risk of patient actually presenting with DVT or PE
If Well’s score result is unlikely, how should you proceed?
D-dimer
If well’s score if likely, how should you proceed with patient management?
CTPA
Name two other conditions in which D dimer is raised
Pneumonia malignancy heart failure surgery pregnancy
Which electrolyte disorder can arise from PE?
respiratory alkalosis
PE and hyperventilation syndrome both can cause respiratory alkalosis. How can you distinguish between the two?
PE- low pO2
Hyperventilation- high pO2
Three immediate aspects of management for non-massive PE?
15L trauma mask O2
Analgesia
LMWH
IV fluids if hypotensive still
Two examples of LMWH?
dalteparin and enoxaparin
What is the management of massive PE?
thrombolysis- alteplase, streptokinase
Two ways in which thrombolysis can be performed?
IV via peripheral cannula
Catheter-directed thrombolysis- directly into pulmonary arteries
Three options for long term management of PE/DVT?
LMWH, NOAC, warfarin
Which anticoagulant is first line in pregnancy and cancer?
LMWH
What is the INR target in long-term management VTE?
2-3
Aside from CTPA, what is another imaging investigation for PE?
Ventilation-perfusion scan
In which patients is V/Q scan indicated when investigation PE?
renal impairment
contrast allergy
risk from radiation e.g. pregnancy
Three advantages of NOAC over warfarin
fixed dose, no monitoring, few drug-drug interactions
For how long should acute PE patients be on anticoagulants for?
min 3 months
For how long are provoked PE’s treated for?
3 months
When would a patient for PE be treated for 6 months?
active cancer and unprovoked confirmed proximal DVT or PE.
