Pulmonary embolism

Question 1

What is a PE?

Answer 1

one or more emobli usually arising from a thrombus formed in the veins are lodged in and obstruct the pulmonary arterial system

Question 2

What is a provoked PE?

Answer 2

Associated with an antecedent (within 3 months) and transient risk factor

Question 3

What is an unprovoked PE?

Answer 3

A PE that happens in the absence of a transient risk factor.

This can mean that the patient does not have any risk factors OR they have a long standing and not correctible risk factor such as active cancer or thrombophilia

Question 4

Symptoms of PE

Answer 4

Chest pain (pleuritic or retrosternal)
SOB
Cough
Haemoptysis
Dizziness
Syncope
Swollen leg associated with DVT

Question 5

What type of shock can be associated with PE?

Answer 5

Obstructive shock

Question 6

How is WELLS score used to determine management?

Answer 6

If Wells is >4, PE is likely
If WELLS is <4 or 4, PE is unlikely

If likely = do a CTPA
If unlikely = do a D-dimer, then if D dimer is positive, do a CTPA. If d dimer is negative, consider ddx

Question 7

When is a V/Q scan preferred in Ix?

Answer 7

For the. patient population who can not tolerate the intravenous contrast e.g. renal failure and pregnancy

Question 8

Components of Wells score

Answer 8

1. Signs and symptoms of DVT (+3)
2. PE is #1 diagnosis OR equally likely (+3)
3. Heart rate > 100 (+1.5)
4. Immobilization at least 3 days OR surgery in the previous 4 weeks (+1.5)
5. Previous, objectively diagnosed PE or DVT (+1.5)
6. Hemoptysis (+1)
7. Malignancy (+1)

Question 9

Acute management of PE

Answer 9

• A-E assessment
• High flow oxygen
• IV access
• Analgesia

Question 10

When is thrombolysis considered as management?

Answer 10

• In cardiac arrest
• Severe haemodynamic instability
  Basically no other option and is done in life threatening presentations
• Needs to be a senior/MDT decision