PULMONARY EMBOLISM

Question 1

Critical DDx

Answer 1

Pulmonary Embolism
Aortic Dissection
Coronary Dissection

Question 2

History and Physical

Answer 2

Shortness of breath: 34.7%
Tachycardia: 30.4%
Chest pain: 13%
Leg pain or weakness: 9.6%

Question 3

Years Algorithm

Answer 3

Does the patient have clinical signs of deep vein thrombosis?
Does the patient have hemoptysis?
Is pulmonary embolism the most likely diagnosis?

If the answer to all three questions is “no,” the D-dimer threshold is set at 1,000 ng/mL fibrinogen equivalent units (500 ng/mL D-dimer units).

If the answer to any of the three questions is “yes,” the D-dimer threshold is set at 500 ng/mL fibrinogen equivalent units (250 ng/mL D-dimer units).

Question 4

Management: High Risk (Massive) Pulmonary Embolism

Answer 4

Thrombolytics

Question 5

Management: High-Intermediate Risk Pulmonary Embolism

Answer 5

Lovenox 1.5 mg/kg daily versus 1 mg/kg twice daily.

Unfractionated Heparin: 2nd line

bolus unfractionated heparin at 80 units/kg followed by a continuous infusion of 18 units/kg/hour.

monitoring every 6 hours to monitor target activated partial thromboplastin (aPTT) levels.

Question 6

ECG Features

Answer 6

1) Sinus Tachycardia
2) Right Axis Deviation
3) Incomplete or complete RBBB
4) Right Ventricular Strain Pattern:
T wave inversion inferior and anteroseptal leads
5) S1, Q3, T3 Pattern:
Large S wave in lead I
Small Q wave in lead III
Inverted T wave in lead III