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exam - M - Respiratory diseases (Megan) > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

1
Q

What is a pulmonary embolism?

A

A blood clot that forms and gets lodged in the pulmonary artery.

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2
Q

Where does. PE usually originate from, what’s its journey?

A

Originates - DVT in leg.
Journey - travels through the venous system, through the right side of the heart and into pulmonary arteries before getting stuck.

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3
Q

Which side of the heart is mostly affected by a PE?

A

The right side - there is increased strain on right side pumping blood to the lungs.

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4
Q

What do the pulmonary arteries carry?

A

Low O2
High CO2
blood - travelling in lungs to give off CO2 and get more O2.

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5
Q

What is VTE?

A

Venous thromboembolism = Pulmonary embolism + Deep vein thrombosis.

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6
Q

What are the risk factors of VTE?

A 
Immobility
Recent surgery
Long haul flights
Pregnancy 
Cancer
Oestrogen hormone therapy
High haemoglobin
Inflammatory conditions
Thrombophilia conditions
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7
Q

What are examples of oestrogen therapy causing risk of VTE?

A

Oral combined contraceptive pill

Hormone replacement therapy

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8
Q

What are examples of inflammatory conditions causing risk of PE?

A

Systemic lupus erythematosus.

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9
Q

What are thrombophiliac conditions causing risk of VTE?

A

Thrombophilia = your blood can form clots too easily.

Antiphospholipid syndrome.

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10
Q

What are the signs/symptoms of PE?

A 
Pleuritic chest pain (sharp pain on deep breathing)
SOB
Collapse
Cough - with or without blood
Hypoxia
Tachycardia
Increased Respiratory rate
Fever
Haemodynamically unstable
Hypotension
Cardiogenic shock
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11
Q

What is haemodynamic shock?

A

A perfusion failure - causing low blood pressure - where blood ends up not being able to perfuse the organs.

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12
Q

What are the signs/symptoms of a DVT?

A

Unilateral pain and/or swelling in leg

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13
Q

What is the prophylaxis for VTE?

A

Injection of low molecular weight heparin. Done if suspected before results.

Compression socks

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14
Q

What are the contraindications of low molecular weight heparin?

A

Pregnancy
Active bleeding
Use of existing anticoagulants

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15
Q

What are the contraindications of compression socks?

A

Peripheral arterial disease.

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16
Q

Which score indicates the likeliness of a PE?

A

WELLS Score.

17
Q

What test is done to investigate a PE?

A

PE likely - CT pulmonary angiogram.

PE unlikely - D-dimer (if this is +, do a CTPA).

18
Q

What is true about eh D dimer test?

A

95% sensitive but NOT specific.

19
Q

What causes a positive D dimer result?

A 
PE
recent surgery
heart failure
pregnancy
Pneumonia
20
Q

What is a CTPA?

A

CT pulmonary angiogram - Chest CT using an IV contract.

1st choice.

21
Q

What are the two imaging tests that can be done?

A

CTPA

Ventilation perfusion scan.

22
Q

What is a VQ scan?

A

Isotopes are inhaled and picture of lungs is taken.

Isotopes are given IV and picture is taken.

Pictures compared - there is a part of the lungs not being perfused due to blood blockage.

  • Scan will show higher ventilation and lower perfusion.
23
Q

What does an ABG show?

A

Respiratory alkalosis - Low O2 causes a high respiratory rate - Blow off too much CO2 and can’t get any new oxygen.

Low O2
Low CO2

24
Q

What are the causes of respiratory alkalosis?

A

Pulmonary embolism - Low O2, low CO2.

Hyperventilation - High O2, low CO2.

25
Q

What is long term treatment?

A

Initial = Low molecular weight heparin.

Warfarin
DOACS - direct acting oral coagulants
Low molecular weight heparin

26
Q

What are the names of heparin?

A

Enoxaparin.

27
Q

What is the target INR dose when using warfarin?

A

INR between 2-3.

28
Q

What should be done if long term warfarin is started?

A

Continue with the initial low weight molecular heparin for first 5 days (or until INR it stable).

29
Q

What are examples of the DOACS?

A

Riveroxaban
Apixaban
Dabigatran

30
Q

Who should take low molecular weight heparin as a long term choice?

A

Pregnant women

People with cancer

31
Q

What is thrombolysis?

A

Injecting a thrombolytic medication (streptokinase, alteplase, tanectoplase) either IV or directly into the pulmonary arteries.

It breaks down fibrin.

exam - M - Respiratory diseases (Megan) (24 decks)

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