Pulmonary Embolism

Question 1

Which A-E

Answer 1

Breathing

Question 2

Airway

Answer 2

Question 3

Breathing

Answer 3

Look: cyanosis, accessory muscle usage, pursed lips, tripoding
Listen: normal vesicular sounds
Feel: normal chest expansion, no tracheal deviation

O2 sats (low), RR (high)

ABG: lactate, hypoxia (type I resp failure with resp alkalosis)
CXR: normal

CTPA or V/Q

WELL’S SCORE

Management:
1. High flow O2 15L via NRB mask

If no shock:
* treatment dose DOAC: apixiban 10mg BD 7 days, 5mg BD maintanence after

If shock:
* urgent consideration for thrombolysis
* alteplase 10mg as slow IV over 1-2 minutes, infusion over 2 hours

Question 4

Circulation

Answer 4

Look: anaemia, peripheral shutdown
Listen: S1+2+0
Feel: apex beat, CRT, pulse

ECG:
* sinus tachycardia OR
* S1Q3T3
* 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.

Bloods:
* FBC, UEs, LFTs, CRP, D-dimer, clotting
* cholesterol, lipids, glucose

2 IV access cannulae

Temperature

If hypotensive - ask for senior support promptly as peri-arrest call

Question 5

Disability

Answer 5

Check drug chart for contraindications to thrombolysis
PEARL, GCS, BM

Question 6

Exposure

Answer 6

check for calf tenderness/ swelling