Pulmonary Embolism

Question 1

What commonly causes a PE to develop?

Answer 1

Occurs when a blood clot dislodges and travels through the circulation

Known as a venous thromboembolism (VTE)

If small may be filtered in the pulmonary capillary bed, if the embolism is large it may occlude the pulmonary blood vessels

Question 2

Common symptoms of PE?

Answer 2

dyspnoea
tachypnoea
pleuritic pain
tachycardia
cough
haemoptysis
leg pain/clinical signs of DVT.

Question 3

Pleuritic chest pain?

Answer 3

sharp chest pain during deep inhalation

Question 4

Clinical signs of DVT?

Answer 4

Pain or tenderness
Reddening or discolouration
Swelling
Difficulty in weight bearing

Question 5

Risk factors for DVT?

Answer 5

Recent trauma
Hormone therapy
Previous history/FMHx of DVT
Pregnancy/recent childbirth
Recent surgery, last 6 weeks
Recent inactivity - travel, sedentary lifestyle
Smoking
Obesity & over 40 years of age
Malignancy (cancer patients)
Varicose veins

Question 6

Signs of PE?

Answer 6

Tachypnoea
Tachycardia
Hypoxia < SpO2 <92%.
Signs of deep vein thrombosis (DVT)

Question 7

Management of a PE?

Answer 7

Primary survey
correcting any <C>ABCD problems
ECG
pain relief where appropriate
300mg Aspirin & 400mcg GTN
ATMIST</C>

Question 8

Time critical features of PE?

Answer 8

extreme breathing difficulty
Cyanosis
severe hypoxia (SpO2) <90% – unresponsive to oxygen.

Question 9

Differential diagnosis for PE?

Answer 9

pleurisy
pneumothorax
cardiac chest pain.

Question 10

Common signs of PE on ECG?

Answer 10

Note classic ECG presentation is often not observed in massive PE

Most common finding is sinus tachycardia

Massive PE can cause significant QT prolongation and T-wave inversion.

S1 Q3 T3
A large S wave in lead I, a Q wave in lead III and an inverted T wave in lead III together indicate acute right heart strain.

Question 11

What score can be used to assess risk of PE?

Answer 11

Wells score