Pulmonary embolism Flashcards

1
Q

What are common symptoms of a PE?

A

dyspnea, chest pain, cough, tachycardia, AMS, bronchospasm, syncope, hypoxia, DVT symptoms (muscle cramping, pain, redness, swelling)

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2
Q

What do nearly almost all hospitalized patients qualify for especially following high-risk surgeries?

A

chemical VTE prophylaxis – lovenox or heparin, utilize PESI to score outpatient vs inpatient (high = admit, low = outpatient management)

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3
Q

What are these risk factors for:
Inherited (factor V leiden)

Acquired - provoking (trauma, surgery, hormone therapy, active cancer)
Non provoking - obesity, smoking
Virchow’s triad

A

PE

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4
Q

What’s the 3rd most common cardio COD?

A

PE

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5
Q

Where do most thromboembolisms come from?

A

lower extremity (proximal veins) or renal + upper extremity from lines

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6
Q

What’s a saddle embolism?

A

at bifurcation, can be “in transit” which = high mortality

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7
Q

50-60% of DVT patients will have ___

A

PE

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8
Q

Normal CXR with hypoxia indicates

A

PE

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9
Q

What would you see on a lung exam of a PE?

A

dyspnea/tachypnea with a normal lung exam, maybe a precordial heave, loud 2nd sound, gallop

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10
Q

What score do you use for clinical risk assessment?

A

Wells score

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11
Q

What is the Pulmonary Embolism Rule-out Criteria (what do the amount of criteria mean)?

A

NO criteria met = PE can be ruled out
If 1 criteria is met = obtain D-dimer
If D-dimer is negative + pre-test probability of PE is low – no further work up
Positive D-dimer = proceed w/ CT PE

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12
Q

What would be shown on an EKG for PE?

A

S1Q3T3

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13
Q

What are rare sightings on a CXR for a PE?

A

normal or wedge-shaped infiltrate, hemi-diaphragmatic elevation, effusion, pulm HTN, atelectasis
Hampton hump, Westermark sign

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14
Q

What scan would you do if intolerance of contrast (pregnant)?

A

V/Q scan

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15
Q

What’s your first line test for PE?

A

CT PE

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16
Q

What are the PERC rule out criterias?

A

> 50
HR>100
O2 sat <95%
prior Hx of DVT/PE
recent trauma/surgery
hemoptysis
exogenous estrogen
unilateral leg swelling

if none are present = rule it out!

17
Q

What type of PE is this:
Hemodynamically unstable
Sustained HOTN (<90 or >40 from baseline for >/ 15 minutes, requiring vasopressor or causing cardiac arrest
Not due to any other cause
Persistent profound bradycardia (<40)
Pulselessness

A

high risk PE (massive) >6

18
Q

What type of PE is this:
Hemodynamically stable
w/o HOTN but RV dysfunction or myocardial necrosis (troponin)

A

intermediate risk PE (submassive, 2-6)

19
Q

What type of PE is this:
Acute PE w/o clinical markers of adverse prognosis

A

low risk PE <2

20
Q

What’s first line for PE?

A

stabilize = O2, intubate, ventilation/IV fluids/vasopressors for HOTN

21
Q

How do you decide inpatient or outpatient for a PE patient?

A

pulmonary embolism severity index

22
Q

What should you start immediately for a PE patient?

A

anticoag - heparin immediately, + transition to warfarin, lovenox, or DOAC (first line transitioning) for a minimum of 3 months

23
Q

When is 3 months of anticoags not considered?

A

in PROVOKED (caused) episodes w/ – the transient risk factor no longer present, isolated distal DVT, subsegmental or incidental PE, risk of bleeding high

24
Q

When are anticoags indicated INDEFINITELY?

A

UNPROVOKED proximal DVT, unprovoked symptomatic PE, active cancer, antiphospholipid antibodies/syndrome, recurrent episode, low risk of bleeding

25
Q

If anticoagulation is CI or bleeding risk is high, what should be placed?

A

IVC filter – preferred to remove when resolved @ 1 year

26
Q

For severe PE, what’s the treatment?

A

catheter-directed embolectomy/thrombolysis,, surgical thrombolysis

27
Q

When is thrombolysis not possible for PE patients?

A

active bleeding, stroke w/n 3 months

probably not in: uncontrolled HTN, surgery or trauma w/n past 4 weeks

28
Q

If a thrombolysis is not possible for a severe PE, what do you do?

A

embolectomy

29
Q

What are general considerations to consider as exceptions to anticoagulation?

A

cancer, pregnancy, patients w/ indefinite anticoagulation

30
Q

PERC Rule – mnemonic (HAD CLOTS)

A

H – hormone use

A – age > 50

D – DVT/PE history

C – Coughing blood

L – Leg swelling (unilateral)

O – O2 < 95%

T – Tachycardia 100+

S – Surgery/trauma < 28 days

31
Q

gold standard for PE dx?

A

angiography

32
Q

wells: eat chip

A

Edema or DVT signs (3)
Alternative Dx unlikely (3)
Tachy (1.5)
Cancer w/n 6 months (1)
Hemoptysis (1)
Immobilization x3d / surg in past 1 month (1.5)
Previous Hx of DVT (1.5)