Pulmonary embolism

Question 1

Risk factors

Answer 1

1. Recent surgery
2. Post partum, pregnancy
3. History of VTE
4. Malignancy
5. Prolonged bed rest
6. Leg fracture
7. Thrombophilia
8. Pill, HRT
9. Obesity, cigarette smoking
10. Sepsis
11. IBD

Question 2

Clinical features

Answer 2

1. Sudden onset dyspnea
2. Chest pain
3. TachyP
4. Cough
5. TachyC
6. Hemoptysis

Question 3

Possible examination findings CV

Answer 3

1. Elevated JVP
2. Sternal heave
3. +S2 pulmonary

Question 4

Investigations

Answer 4

1. FBC, UEC, coagulation as baseline
2. ABG->hypoxemia, hypocapnia
3. ECG->sinus tachyC, RBBB. RV strain, S1Q3T3
4. CXR-> band atelectasis, elevation of hemidiaphragm, prominent central pulmonary artery
5. D-Dimer
6. +Wells score
7. VQ scan->normal reading is the best imaging to exclude PE. High reading with high clinical probability= PPV 96%
8. CTPA->imaging of choice in those with high probability of PE: direct visualisation of thrombus in central pulmonary vein
9. Consider thrombophilia screen

Question 5

Management

Answer 5

1. ABC
2. Oxygen
3. IV access. Bloods: FBC, coags, UEC. Do ABG. Do ECG, CXR. Arrange CTPA if high risk or VQ scan->confirm diagnosis
4. Morphine + antiemetic
5. If massive consider alteplase (sustained hypotension, heart failure, severe hypoxemia)or IVC filter
6. Heparin infusion->adjust according to APTT, monitor PLT count
7. If BP rapid colloid infusion 500ml
8. Start warfarin regime