Pulmonary Embolism Flashcards
What is a pulmonary Embolism
Common, serious, potentially fatal blockage within the pulmonary circulation.
Why do <10% of patients with fatal emboli receive treatment for the condition?
It’s not recognized.
What’s a major concern for survivors of PE?
The next PE could kill them. It’s important to treat the source of the emboli.
What are etiologies of PE?
Thrombus (blood clot- most common)
Air
Fat
Tacl powder during IVDA
Parasite Eggs
Tumor cells
Where do thrombotic etiologies originate?
In the lower extremities as a DVT deep vein thrombosis in calves.
What the problem with DCTs in the calves?
20% spread proximally past the knee (popliteal space) increasing the likelihood of embolization.
What is virchow’s triad?
Risk factors for PE: Venous stasis, Injury to vessel wall, hypercoagulability
What are the signs and symptoms of a DVT?
Swelling, pain, tenderness of extremity, calf pain with forceful dorsiflexion of the ankle.
What is Homan’s sign?
Dorsiflexion of the ankle.
What diagnostic do you use to find a DVT?
Ultrasound venous doppler.
What are symptoms of PE?
Pleural chest pain/back pain
Dyspnea
Tachypnea
Tachycardia
Decreased O2 SAT
Low grade fever
Feelings of anxiety
Evidence of DVT
What do you see on an EKG on a pt with PE?
Right heart strain
T wave inversions in the right precordial leads (V1-4) and the inferior leads II, III, aVF
SIQIIITIII Pattern: Deep S wave in lead I, Q wave in lead III, inverted T wave in lead III
What are two algorithms we use to guide diagnostics? Which do you start out with?
Well’s Criteria for PE, and PERC.
Well’s.
What are the 7 questions for the wells criteria? IN ORDER
3 Clinical signs and symptoms of DVT?
3 PE is #1 diagnosis or likely
1.5 Heart rate > 100
1.5 Immobilization at least 3 days OR surgery in the previous 1.5 4 weeks.
1.5 Previous, objectively diagnosed PE or DVT?
1 Hemoptysis
1 Malignancy w/ treatment within 6 months or palliative?
What happens after you added your points for the Well’s criteria?
=< 4 PERC for possible D-dimer
> 4 CT Lung angiogram
What are the 8 questions for PERC?
Age =>50
Hr = > 100
SaO2 <95%
Unilateral leg swelling
Hemoptysis
Recent surgery or trauma
Prior PE or DVT
Hormone Use
All worth 1 point
What is the score criteria for PERC?
Any positive answer requires D-dimer
What is the gold standard for the diagnosis of PE?
Pulmonary angiography- you will see filling defect
What is the diagnostic study of choice for PE?
CT Pulmonary agiography
What study do you use if your suspect your pt is pregnant or tells you they are allergic to contrast
V/Q scan- but its usually not recommended due to the possible “indeterminant” result
Treatment for PE?
Anticoagulate if caused by thrombus
- Can be Admitted or
- If discharged injections of enoxaparin x 3 + oral warfarin immediately
(3 days actually increases coagulability)
IVC Filter
What is the prognosis of PE?
Good if the cause is identified and treated appropriately
What is an important patient education concept to talk with your pt?
Some patients will require life long anticoagulation
