PULMONARY EMBOLISM Flashcards
Pulmonary embolism results from thrombi often from the …………….. transported via …….. into the pulmonary vasculature
Deep veins of the lower limbs or pelvis,
the right heart
Symptoms of PE
Dyspnea
Pleuritic pain
Cough
Hemoptysis
Presyncope, syncope or collapse
Unilateral swelling of a limb
Which type of PE presents with presyncope, syncope or collapse
Massive PE
Signs of pulmonary embolism
Tachypnea
Tachycardia
BP can be low, normal or high
Pleural effusion
Low oxygen saturation <90% on pulse oximetry
Pleural rub
Cyanosis
Unilateral swollen calf or thigh of DVT
Low or unrecordable blood pressure is seen in which type of PE
Massive pulmonary embolism
Well’s score for pulmonary embolism
Symptoms of DVT - (3)
No alternative diagnosis better explains the illness - (3)
Tachycardia with pulse > 100 - (1.5)
Immobilization (>= 3 days) or surgery in the previous four weeks (1.5)
Prior history of DVT or PE (1.5 )
Presence of hemoptysis (1)
Presence of malignancy (1)
Well’s score interpretation for PE
> 6- High
2 to 6- moderate
<2- low
Investigations for PE
Chest X-ray
ECG
D-dimer
CT pulmonary angiogram
Echocardiography
Doppler ultrasound of the affected limb and pelvis
FBC
Treatment objectives in PE
To stabilise cardio-respiratory function
To prevent further clot formation and embolisation
To prevent recurrence and development of pulmonary hypertension
Examples of surgical techniques in PE
Embolectomy
Inferior vena cava filters
Non-pharmacological management of PE
Elevate affected leg on a pillow if DVT present
Compression stockins
Surgical techniques
Treatment algorithm for PE
Oxygen to keep SPO2>95%
and
Morphine
and
SC Enoxaparin or Dalteparin
and
Warfarin
Dose of enoxaparin in PE
Adult
1.5mg/kg (150U/Kg) daily
Dose of morphine in PE
Morphine IV 5 to 10mg stat.
