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Respiratory System > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

1
Q

What are the types of embolism?

A

Thrombus
Fat
Air
Amniotic fluid
Foreign material

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2
Q

What is a venous thromboembolism?

A

Embolism caused by thrombus formed in the venous system e.g. DVT

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3
Q

What will happen to thrombi from a systemic vein?

A
  • travels though the right side of the heart
  • impacts the lungs
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4
Q

What is part of virchow’s triad?

A
  • haemodynamic changes: stasis/turbulence
  • hypercoagulability
  • vessel wall damage
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5
Q

What is the highest risk factor of pulmonary embolism?

A

Increasing age

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6
Q

Risk factors for PE

A
  • increasing age
  • surgery
  • prolonged immobility
  • previous proven VTE
  • long haul flight
  • abdominal/pelvic surgery
  • pregnancy
  • obesity
  • smoking
  • malignancy
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7
Q

What can cause vessel wall damage?

A
  • vascular access
  • injury/trauma
  • varicose veins
  • increasing age
  • surgery
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8
Q

What are causes for haemodynamic changes?

A
  • prolonged immobility
  • pregnancy
  • obesity
  • varicose veins
  • increasing age
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9
Q

What are causes for hypercoagulability?

A
  • thrombophilia - high platelets
  • oestrogen containing meds
  • cancer
  • smoking
  • pregnancy
  • obesity
  • increased age
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10
Q

What are the three main impacts of pulmonary embolisms?

A

Acute right heart strain
Respiratory failure
Pulmonary infarction

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11
Q

How do pulmonary embolism cause acute right sided heart failure?

A
  • increased pressure in pulmonary artery
  • causes RV dilatation > acute right sided heart failure
  • inotropes released to maintain systemic BP
  • causes vasoconstriction of pulmonary artery
  • increases pressure even more
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12
Q

Symptoms of a pulmonary embolism

A
  • dyspnoea
  • pleuritic chest pain
  • cough
  • syncope
  • haemoptysis
  • unilateral leg pain/swelling (DVT)
  • diaphoresis
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13
Q

Signs of pulmonary embolism

A
  • dyspnoea
  • tachycardia
  • Tachypnoea
  • low BP
  • raised JVP
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14
Q

How can pulmonary embolisms cause pulmonary infarction?

A
  • small emboli cause alveolar haemorrhage + infarction of lung tissue
  • causes haemoptysis, pleuritis + small pleural effusion
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15
Q

How do pulmonary infarction appear on a CXR?

A

Wedge or Hampton hump

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16
Q

What are the classic findings on an ECG of a patient with pulmonary embolism?

A

sinus tachycardia
SI QIII TIII
- Deep S wave in lead I
- Pathological Q wave in lead III
- Inverted T wave in lead III

17
Q

Investigations of PE

A
  • ABG: shows respiratory alkalosis
  • chest X ray: exclude differentials
  • ECG: sinus tachycardia SI QIII TIII
  • D dimers
  • Wells score
  • CT pulmonary angiogram
  • V/Q scan
18
Q

Diagnosis of PE

A
  • CT pulmonary angiogram - gold standard
  • V/Q single photon emission CT scan
  • plantar VQ scan
19
Q

A PE can be ruled out if patient is D dimer … and … risk

A

A PE can be ruled out if patient is D dimer negative and low risk

20
Q

When is a D dimer test useful for PE?

A

Only when a patient is at a low risk of PE
(Negative test = rules out PE)
Well’s score <4

21
Q

How do we decided if a patient is at high or low risk of a pulmonary embolism?

A

Well’s score

22
Q

What is the normal level for D dimer?

A

0.5

23
Q

What can cause raised D-dimer?

A
  • PE
  • pneumonia
  • malignancy
  • heart failure
  • pregnancy
  • surgery
24
Q

What is the first line drug treatment of a PE?

A

Low molecular weight heparin

25
Q

Treatment of pulmonary embolisms

A
  • O2 if hypoxic
  • analgesia if pain
  • sc LMWH whilst awaiting CTPA
  • fully anticoagulated once confirmed diagnosis
26
Q

Thrombolysis contraindications

A

absolute:
- stroke <6 months ago
- CNS neoplasia
- GI bleed <1 month ago
- recent trauma or surgery
- aortic dissection
.
relative:
- DOAC/warfarin
- pregnancy
- advanced liver disease
- infective endocarditistiis

27
Q

Further treatment of pulmonary embolism in severe cases (massive PE)

A

Haemodynamic support
Respiratory support
Surgical intervention

28
Q

When patients are discharged after a PE they are normally switched to a oral anticoagulant, how long do they need this for?

A
  • 3 months if identifiable temporary risk factor
  • indefinitely if no identifiable risk factor
29
Q

VTE prophylaxis

A
  • LMWH e.g. enxaparin given to high risk patients
  • warfarin or DOAC if contraindicated
30
Q

Prevention of pulmonary embolisms

A
  • anticoagulants
  • mobilisation
  • TED stockings/AES
  • intermittent pneumatic compression
  • fall prevention
  • avoid unnecessary invasive procedures
31
Q

How can pulmonary embolisms cause respiratory failure?

A
  • low RV output
  • reduced perfusion to lungs
  • V/Q mismatch
  • low pO2
32
Q

How does heparin induced thrombocytopenia occur?

A
  • antibodies form against heparin
  • bind to heparin platelet complexes
  • platelets become activated + clump together
  • thrombi form
  • thrombi spread through body
  • risk of causing stroke, MI + limb ischameia
33
Q

Main differential diagnosis for PE

A
  • pneumothorax
  • pneumonia
  • MSK chest pain
  • MI
34
Q

Why is distended neck veins (raised JVP) a sign of PE?

A

Increased pulmonary artery pressure
More difficult for RV to empty

IJV drains into subclavian vein > superior vena cava > right side of the heart

35
Q

What should be considered in an unprovoked PE?

A

Underlying malignancy or thrombophilia

36
Q

What is massive haemoptysis defined as?

A

> 240mls in 24 hours
OR
100mls/day over consecutive days

37
Q

Management of massive haemoptysis

A
  • lie patient on side of suspected lesion
  • oral tanexamic acid for 5 days
  • stop NSAIDs, aspirin, anticoagulants
  • consider vitamin K
  • CT aortogram
  • antibitoics if suspected RTI
38
Q

What is a massive PE?

A

A PE that causes haemodynamic instability e.g. hypotension, shock, RV dysfunction on imaging

39
Q

Treatment of massive PE

A

Thrombolysis with IV alteplase
Surgical or catheter directed thrombectomy

Respiratory System (25 decks)

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