Pulmonary Embolism

Question 1

Your pt who has a predisposition to venous thrombosis, especially in the lower extremities. presents with these issues. What do you suspect?
(1) Acute onset of dyspnea, pleuritic chest pain,
tachypnea, and tachycardia.
(2) Elevated rapid D-dimer, characteristic defects on ventilation-perfusion lung scan, helical CT scan, or pulmonary angiogram.

Answer 1

Pulmonary Embolism

Question 2

What is the most common emboli for PE

Answer 2

thrombi

Question 3

True/false
Clots that form pulmonary emboli are most commonly from the femoral or pelvic venous beds

Answer 3

True

Question 4

Clots confined to the upper extremity commonly embolize into the pulmonary circulation.

Answer 4

False
Clots confined to the lower leg and upper extremity rarely embolize into the pulmonary circulation.

Question 5

PE will develop within 50-60% of patients with ________

Answer 5

proximal deep vein thrombosis

Question 6

Risk factors for pulmonary embolism are the same as for deep vein thrombosis What is the triad called?

Answer 6

Virchow’s Triad

Question 7

What is Virchow’s Triad

Answer 7

-Venous stasis
-Injury to the vessel wall
-Hypercoagulability

Question 8

Venous stasis increases with….

Answer 8

-Immobility
-Hyper viscosity
-Increased central venous pressure (pregnancy, low cardiac output)

Question 9

Injury to the vessel wall can be due to….

Answer 9

1) Prior episodes of thrombosis
2) Orthopedic surgery
3) Trauma

Question 10

Hypercoagulability can be caused by

Answer 10

1) Medications (OCP, hormone replacement)
2) Inherited gene defects

Question 11

Small to medium emboli can cause

Answer 11

localized obstruction of the pulmonary
vasculature.

Question 12

Massive embolization causes

Answer 12

acute pulmonary hypertension, right heart strain, systemic hypotension, and shock

Question 13

Physical exam findings for what?
(1) Onset often is abrupt, and one or more of the DVT risk factors is almost always present.
(2) Dyspnea, cough, anxiety, and chest pain occur in varying combinations.
(3) Hemoptysis, tachycardia, and tachypnea are common.
(4) Low grade fever, hypotension, cyanosis, DVT signs, and pleural friction rub may be present.

Answer 13

Pulmonary edema

Question 14

True/False
Operational environment requires the IDC to rely on history and physical exam for recognition and early treatment of suspected PE.

Answer 14

True… good luck

Question 15

True/false
Most likely, the IDC will not definitively diagnose a pulmonary embolism

Answer 15

True….. =[

Question 16

Although not specific for PE, the ECG may show

Answer 16

ST and T wave abnormalities

Question 17

Differential Diagnosis for PE – Must consider causes of chest pain and dyspnea

Answer 17

(1) Cardiac
(2) Pulmonary
(3) Trauma
(4) GI
(5) Musculoskeletal
(6) Psych

Question 18

What is a clinical prediction tool for PE?

Answer 18

Wells criteria, PERC

Question 19

Wells criteria and pulmonary rule out criteria:
Scores > PE likely and less than or equal to 4 PE is….

Answer 19

unlikely

Question 20

PE tx
to correct hypoxemia what would you use?

Answer 20

2 – 15 LPM based on oxygen saturation and respiratory effort
-through nasal cannula, simple mask, non-rebreather mask, or advanced airway.

Question 21

True/false
Use caution in long term O2 therapy with chronic COPD/Emphysema patients

Answer 21

True

Question 22

What med and dose would you use for PE

Answer 22

Lovenox 1 mg/kg subcutaneously q 12 hours

Question 23

________therapy may be required for some patients, such as those with right heart dysfunction, hemodynamic compromise, or cardiogenic shock

Answer 23

Thrombolytic therapy

Question 24

Does lovenox bust the clot?

Answer 24

no

Question 25

What drugs are used to bust clots

Answer 25

Streptokinase, urokinase, and recombinant tissue plasminogen activator

Question 26

Pulmonary embolism patients will need…….

Answer 26

ongoing anticoagulation and supportive care.

Question 27

True/false
The IDC will manage the care of a PE patient. MEDEVAC is not necessary.

Answer 27

FALSE
The IDC will not manage the care of this patient. MEDEVAC as soon as possible

Question 28

What intervention is necessary for a PE patient when anticoagulation or thrombolytic therapy is contraindicated?

Answer 28

surgical intervention to remove the clot

Question 29

Air embolization occurs most commonly after…..

Answer 29

penetrating trauma

Question 30

The reference standard for PE diagnosis is….

Answer 30

pulmonary angiography

Question 31

The reference standard for PE diagnosis is….

Answer 31

pulmonary angiography