pulmonary embolism Flashcards
features of PE?
tachypnoea
crackles
tachycardia
chest pain
typically pleuritic
dyspnoea
haemoptysis
chest clear on auscultation
what are the ix?
Well’s criteria + CXR
what is the wells criteria?
what do you do if PE likely?
arrange an immediate computed tomography pulmonary angiogram (CTPA)
If there is a delay in getting the CTPA then interim DOAC
if the CTPA is positive then a PE is diagnosed
if the CTPA is negative then consider a proximal leg vein ultrasound scan if DVT is suspected
what do you do if PE unlikely?
arranged a D-dimer test
if positive arrange an immediate computed tomography pulmonary angiogram (CTPA). If there is a delay in getting the CTPA then give interim therapeutic anticoagulation until the scan is performed
if negative then PE is unlikely - stop anticoagulation and consider an alternative diagnosis
when do you do CTPA and V/Q?
CTPA is now the recommended initial lung-imaging modality for non-massive PE.
V/Q scanning is also the investigation of choice if there is renal impairment
ECG findings in PE?
MOST COMMON - sinus tachycardia
the classic ECG changes seen in PE are a large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III - ‘S1Q3T3’. However, this change is seen in no more than 20% of patients
right bundle branch block and right axis deviation are also associated with PE
what are CXR findings in PE?
it is typically normal in PE
possible findings include a wedge-shaped opacification
how long is pt anti coagulated for?
if the VTE was provoked the treatment is typically stopped after the initial 3 months (3 to 6 months for people with active cancer)
if the VTE was unprovoked then treatment is typically continued for up to 3 further months (i.e. 6 months in total)
what is mx if pt haemodynamically unstable?
thrombolysis is now recommended as the first-line treatment for massive PE where there is circulatory failure (e.g. hypotension)
