pulmonary embolism Flashcards
what is PE?
blockage in the pulmonary artery (the blood vessel that carries blood from the heart to the lungs).
how does PE arise?
from the propagation of the lower limb DVT; blood clots from the leg’s deep veins break off and go to the pulmonary arterial circulation.
what are 7 risk factors?
Previous PE
Prolonged bed rest
Pregnancy
HRT
Leg Fracture
Recent Surgery
Thrombophilia.
how does PE cause respiratory alkalosis?
Pulmonary embolism causes hyperventilation, causing a drop in arterial carbon dioxide partial pressure and thus respiratory alkalosis.
what are the 5 symptoms?
Acute Breathlessness
Pleuritic Chest Pain
Haemoptysis
Pre-syncope
ScaredCough
*If massive PE = Sudden chest pain, breathlessness, collapse, low BP. Do surgery, Thrombolysis, ECG
what are signs of PE?
Pyrexia - in 45% of people
Pleural Rub
Pleural effusion
Hypoxia
Hypotension
Unwell
Tachypnea (Abnormally rapid breathing) - in 95% of people
Tachycardia (Abnormally rapid heart rate) - in 45% of people
Raised JVP
Dullness on Percussion
Cyanosis
what investigations are carried out for diagnosing PE?
Wells Score
Arterial Blood Gases (this may show decreased PaO2 and decreased PaCO2.
CT Pulmonary Angiography (CTPA) (NICE Investigation of choice, but NOT if renal impairment)
CXR (maybe normal, or can show oligaemia of affected segment, dilated pulmonary artery, linear atelectasis, small pleural effusion, or cavitation).
ECG (maybe normal, or can show tachycardia, right bundle branch block, right ventricular strain). (The most common ECG change seen in Pulmonary Embolism is Sinus Tachycardia)
D Dimer
Increased Troponin
V/Q Scan *If there was a delay in doing V/Q scan, but a high suspicion of PE, then start LMWH treatment
what are some treatments for PE?
Low Molecular Weight Heparin (LMWH)
Oxygen
Thrombolysis (Alteplase - 10mg IV over one minute, then 90mg IVI over two hours)
