pulmonary embolism

Question 1

ECG changes in PE

Answer 1

sinus tachy
non-specific ST segment changes
T-wave abnormalities
right axis deviation
right bundle branch block

Question 2

scoring system for PE

Answer 2

WELLS score

Question 3

Wells score facotrs

Answer 3

clinicla signs and symptoms of DVT

PE is primary diagnsis

heart rate >100bpm

immobilisation for >3 days or surgery in last 4 weeks

previous, objectively diagnosed PE or DVT

haemoptysis

malignancy and treatment within 6 months or palliative

Question 4

what wells score requires immediate CTPA?

Answer 4

> 4

• PE likely

Question 5

wells score <4

Answer 5

PE unlikely

D-dimer required

Question 6

immediate pharmacological management of PE

Answer 6

start anticoagulation as per trust guidelines with LMWH

Question 7

referrals for PE

Answer 7

Discuss with senior member of the team

Contact critical care outreach team

Referral to respiratory team

Consider referral to Intensive Care Unit (ICU)

Question 8

when to consider referral to ICU in PE

Answer 8

Failure to respond to medical management

Patient requires ventilator support

Patient requires blood pressure support

Deterioration of blood gas following medical management

Question 9

future management of PE

Answer 9

review by respiratory team regarding future medical management