Pulmonary Embolism Flashcards
what is a pulmonary embolism
occlusion of pulmonary vessels, most commonly by a thrombus that has travelled to the pulmonary vascular system from another site e.g. a DVT
what are the causes of a pulmonary embolism
a thrombus; mostly from the DVT in lower limbs
thrombus is rarely from the right atrium due to AF
what are some risk factors for PE
surgery, immobility, obesity, OCP, heart failure and malignancy
epidemiology
10-20% of patients that have DVT will develop PE
presenting symptoms (the classic triad) - of a moderate sized PE
sudden shortness of breath, pleuritic chest pain, haemoptysis and cough
presenting symptoms of a large PE
severe, central pleuritic chest pain, shock, collapse, acute right heart failure, sudden death PLUS haemoptysis, SOB
what may small multiple recurrent PE present with
pulmonary hypertension
can a small PE by asymptomatic
often asymptomatic and may have NO signs on examination
what signs of PE on examination
Classically tachypnoea, tachycardia and hypoxia is present. There may be low-grade pyrexia. Tachycardia may be the only presenting sign.
A massive pulmonary embolism may present with hypotension, cyanosis, and signs of right heart strain (such as a raised JVP, parasternal heave, and loud P2)
what else to look for in suspected PE
DVT- lower limb vascular exam
what is used to determine what investigations will be done
Well’s Score;
low probability (low Wells score)- D-dimer test
high probability (high Wells score)- required imaging
investigations for PE
bloods- ABG, thrombophilia screen
ECG- may be normal, may show tachycardia, right acis deviation of RBBB
CXR- often is normal but excludes other diagnoses
spiral CT pulmonary angiogram (FIRST LINE)
doppler US of Lower limb (for DVT)
primary prevention of pulmonary embolism
compression stockings and heparin prophylaxis, good mobilisation and hydration
if the patient is haemodynamically stable and has a PE, what will be the management
oxygen,
anticoagulation (heparin of LMWH),
switch to oral warfarin for 3 months (maintain INR 2-3)
analgesia
if the patient is haemodynamically UNSTABLE (huge PE) what will be the management
resuscitate, oxygen, IV fluids, thrombolysis
