Pulmonary embolism Flashcards
What is a pulmonary embolism?
A thrombus in the pulmonary arteries
What are the risk factors for PE?
Immobility
Recent surgery
Long haul travel
Pregnancy
Oestrogen therapy
Malignancy
Polycythaemia
SLE
Thrombophilia
What are the symptoms of PE?
Pleuritic chest pain
Dyspnoea
Cough
Haemoptysis
Fever
Syncope
What are the clinical signs of PE?
Tachypnoea
Tachycardia
Hypoxia
DVT
Pyrexia
Hypotension
Elevated JVP
What is the PERC score?
A score that is used to rule out a PE:
- Age > 50
- HR > 100
- O2 sats < 95
- Unilateral leg swelling
- Haemoptysis
- Recent surgery or trauma
- Prior PE or DVT
- Hormone use
What components make up the Wells score?
Clinical signs and symptoms of a DVT
PE is the number 1 diagnosis or equally likely
Tachycardia > 100
Immobilisation for more than 3 days or surgery in the previous four weeks
Previous PE or DVT
Haemoptysis
Malignancy with treatment within the last 6 months
What are the primary investigations for PE?
CXR - exclude alternative pathology
ECG - sinus tachycardia
D- dimer
CTPA - gold standard
What other conditions can cause a raised D dimer?
Pneumonia
Malignancy
Heart failure
Surgery
Pregnancy
What is the management of a massive PE?
Thrombolysis
What is the management of a non-massive PE?
Provoked - anticoagulation for 3 months
Unprovoked - anticoagulation for 6 months
- Anticoagulation is usually apixaban or rivaroxaban
What anticoagulant can be used in renal impairment?
LMWH
Unfractionated heparin
What is the first line anticoagulant in pregnancy?
LMWH
How long should anticoagulation be given in cancer patients?
3-6 months and then review
What is the investigation of choice for PE in renal impairment?
V/Q scan (contrast used in CTPA is nephrotoxic)
