Pulmonary Embolism Flashcards
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.
Pulmonary Embolism
What is the most common emboli for PE
thrombi
True/false
Clots that form pulmonary emboli are most commonly from the femoral or pelvic venous beds
True
Clots confined to the upper extremity commonly embolize into the pulmonary circulation.
False
Clots confined to the lower leg and upper extremity rarely embolize into the pulmonary circulation.
PE will develop within 50-60% of patients with ________
proximal deep vein thrombosis
Risk factors for pulmonary embolism are the same as for deep vein thrombosis What is the triad called?
Virchow’s Triad
What is Virchow’s Triad
-Venous stasis
-Injury to the vessel wall
-Hypercoagulability
Venous stasis increases with….
-Immobility
-Hyper viscosity
-Increased central venous pressure (pregnancy, low cardiac output)
Injury to the vessel wall can be due to….
1) Prior episodes of thrombosis
2) Orthopedic surgery
3) Trauma
Hypercoagulability can be caused by
1) Medications (OCP, hormone replacement)
2) Inherited gene defects
Small to medium emboli can cause
localized obstruction of the pulmonary
vasculature.
Massive embolization causes
acute pulmonary hypertension, right heart strain, systemic hypotension, and shock
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.
Pulmonary edema
True/False
Operational environment requires the IDC to rely on history and physical exam for recognition and early treatment of suspected PE.
True… good luck
True/false
Most likely, the IDC will not definitively diagnose a pulmonary embolism
True….. =[
Although not specific for PE, the ECG may show
ST and T wave abnormalities
Differential Diagnosis for PE – Must consider causes of chest pain and dyspnea
(1) Cardiac
(2) Pulmonary
(3) Trauma
(4) GI
(5) Musculoskeletal
(6) Psych
What is a clinical prediction tool for PE?
Wells criteria, PERC
Wells criteria and pulmonary rule out criteria:
Scores > PE likely and less than or equal to 4 PE is….
unlikely
PE tx
to correct hypoxemia what would you use?
2 – 15 LPM based on oxygen saturation and respiratory effort
-through nasal cannula, simple mask, non-rebreather mask, or advanced airway.
True/false
Use caution in long term O2 therapy with chronic COPD/Emphysema patients
True
What med and dose would you use for PE
Lovenox 1 mg/kg subcutaneously q 12 hours
________therapy may be required for some patients, such as those with right heart dysfunction, hemodynamic compromise, or cardiogenic shock
Thrombolytic therapy
Does lovenox bust the clot?
no
What drugs are used to bust clots
Streptokinase, urokinase, and recombinant tissue plasminogen activator
Pulmonary embolism patients will need…….
ongoing anticoagulation and supportive care.
True/false
The IDC will manage the care of a PE patient. MEDEVAC is not necessary.
FALSE
The IDC will not manage the care of this patient. MEDEVAC as soon as possible
What intervention is necessary for a PE patient when anticoagulation or thrombolytic therapy is contraindicated?
surgical intervention to remove the clot
Air embolization occurs most commonly after…..
penetrating trauma
The reference standard for PE diagnosis is….
pulmonary angiography
The reference standard for PE diagnosis is….
pulmonary angiography
