Pulmonary Embolism Flashcards
Risk factors for PE?
Hormone therapy with oestrogen
Malignancy
Pregnancy
SLE
Thrombophilia
Polycythaemia
Immobility
Recent surgery
Long haul flights
What do you give prophylactically to patients to reduce risk of DVT and PE?
Low molecular weight heparin i.e enoxaparin
What is the main contraindication of anti-emboli compression stockings?
Peripheral arterial disease
Presentation of PE?
Short of breath
Cough with/out haemoptysis
Pleuritic chest pain
Hypoxia
Tachycardia
Raised resp rate
Low grade fever
Haemodynamic instability causing hypotension
In DVT unilateral leg swelling and tenderness
What is the scoring system for DVT or PE?
Wells- takes into account surgery, tachycardia>100, haemoptysis
If likely perform CTPA, if unlikely d-dimer then CTPA
Pulmonary embolism rule out criteria PERC if less than 15%
In wells- if more than 4 PE likely and 4 or less is unlikely
2 main ways of diagnosing PE?
CTPA or VQ scan
When is VQ scan used?
Renal impairment, contrast allergy, risk from radiation where CTPA is unsuitable.
What is the ABG in PE?
Respiratory alkalosis due to blowing of CO2
Hyperventilation syndrome is other cause but with high pO2, PE have low pO2
What is initial recommended treatment?
Apixaban or Rivaroxaban. Use LMWH in antiphospholipid syndrome.
Target INR for warfarin?
2-3
If switching to warfarin what should you do?
Continue LMWH for 5 days, or INR is 2-3 for 24 hours on warfarin
What is first line treatment in pregnancy or cancer?
DOACS
How long should you continue anticoagulation?
- 3 months if reversible cause
- Beyond 3 months- cause unclear, recurrent VTE, or irreversible cause thrombophilia
- 6 months in active cancer
What to use in a massive PE?
Fibrinolytic medication e.g streptokinase, alteplase and tenecteplase
Thrombolysis can occur in 2 ways?
- IV through peripheral cannula
- Directly into pulmonary arteries using central catheter Catheter-directed thrombolysis
