Pulmonary Embolism

Question 1

Symptoms of PE

Answer 1

• Chest pain (pleuritic)
• SOB
• Haemoptysis
• Low cardiac output by collapse (if massive PE)

Question 2

Major risk factors for PE

Answer 2

• Surgery - abdo/pelvic/knee or hip replacement, post op spell on ITU
• Obstetric - late pregnancy, C section
• Lower limb - fracture or varicose veins
• Maliganncy
• Reduced mobility
• Previous proven VTE

Question 3

What if no risk factors present but still suspect PE?

Answer 3

• Unprovoked PE
• No obvious risk factor
• In these cases consider underlying malignancy or thrombophilia

Question 4

PE managament

Answer 4

• A-E approach
• Oxygen if hypoxic
• Analgesia if pain
• SC LMWH whilst awaiting CTPA
• Fully anticoagulated once confirmed diagnosis on CTPA

Question 5

Signs of massive PE

Answer 5

• Hypotension/iminent cardiac arrest
• Signs of right heart train on CT/Echo

Question 6

Management of massive PE

Answer 6

• Same as normal PE
• But consider thrombolysis with IV alteplase
• BUT risk of intracerebral haemorrhage bleed 4%

Question 7

Thrombolysis contraindications - absolute (6)

Answer 7

• Haemorrhagic stroke or ischaemic stroke <6 months
• CNS neoplasia
• Recent trauma or surgery
• GI bleed <1 month
• Bleeding disorder
• Aortic dissection

Question 8

Thrombolysis contraindications - relative (4)

Answer 8

• Warfarin / DOAC
• Pregnancy
• Advanced liver disease
• Infective endocarditis

Question 9

Indications for high flow O2

Answer 9

• Cardiorespiratory arrest
• Peri-arrest
• Anaphylaxis
• Any presentation with sats <85% on air
• Carbon monoxide poisoning

In all other situations, if oxygen is required because of low sats, use controlled O2

Question 10

How long is pt on DOAC for after discharge for PE?

Answer 10

3 months if proved
Up to 6 months if unprovoked

Question 11

Diagnosing PE

Answer 11

• Calculate Well’s score
• If more than 4 - PE likely to just do CTPA
• If 4 or less do D-dimer