Pulmonary Embolism Flashcards
What is pulmonary embolism?
Blood clot that develops in a blood vessel elsewhere in the body, travels to an artery in the lung, and suddenly forms a blockage of the artery
What is usually the cause of pulmonary embolism?
Usually secondary to deep vein thrombosis
Where do blood clots commonly form that lead to pulmonary embolism?
In deep veins, usually in the leg or pelvis
What does the acronym THROMBOSIS stand for in relation to pulmonary embolism risk factors?
T: Travel, H: Hypercoagulable state, R: Recreational drugs, O: Old age, M: Malignancy, B: Birth control pills, O: Obesity, S: Surgery, I: Immobilisation, S: Serious illness
What does the ‘T’ in THROMBOSIS represent?
Travel (long hours), trauma, thrombophilia
What does the ‘H’ in THROMBOSIS represent?
Hypercoagulable state, Hormone Replacement Therapy (HRT)
What does the ‘R’ in THROMBOSIS represent?
Recreational drugs, IV drug use
What does the ‘O’ in THROMBOSIS represent?
Old age
What does the ‘M’ in THROMBOSIS represent?
Malignancy (e.g., polycythemia, thrombocythemia, prostate, liver, gastrointestinal, kidney, breast)
What does the ‘B’ in THROMBOSIS represent?
Birth control pills
What does the second ‘O’ in THROMBOSIS represent?
Obesity, obstetric (pregnancy)
What does the ‘S’ in THROMBOSIS represent?
Surgery
What does the ‘I’ in THROMBOSIS represent?
Immobilisation or iatrogenic factors (e.g., infected indwelling catheters, pacemaker wires)
What does the last ‘S’ in THROMBOSIS represent?
Serious illness
What are common presentations of pulmonary embolism?
- Sudden shortness of breath (SOB)
- Haemoptysis
- Palpitations
- Sharp chest pain, worse on inspiration
- Sweating
- Dizziness, fainting
- Anxiety
What is pulmonary embolism?
Blood clot that develops in a blood vessel elsewhere in the body, travels to an artery in the lung, and suddenly forms a blockage of the artery
What is usually the cause of pulmonary embolism?
Usually secondary to deep vein thrombosis
Where do blood clots commonly form that lead to pulmonary embolism?
In deep veins, usually in the leg or pelvis
What does the acronym THROMBOSIS stand for in relation to pulmonary embolism risk factors?
T: Travel, H: Hypercoagulable state, R: Recreational drugs, O: Old age, M: Malignancy, B: Birth control pills, O: Obesity, S: Surgery, I: Immobilisation, S: Serious illness
What does the ‘T’ in THROMBOSIS represent?
Travel (long hours), trauma, thrombophilia
What does the ‘H’ in THROMBOSIS represent?
Hypercoagulable state, Hormone Replacement Therapy (HRT)
What does the ‘R’ in THROMBOSIS represent?
Recreational drugs, IV drug use
What does the ‘O’ in THROMBOSIS represent?
Old age
What does the ‘M’ in THROMBOSIS represent?
Malignancy (e.g., polycythemia, thrombocythemia, prostate, liver, gastrointestinal, kidney, breast)
What does the ‘B’ in THROMBOSIS represent?
Birth control pills
What does the second ‘O’ in THROMBOSIS represent?
Obesity, obstetric (pregnancy)
What does the ‘S’ in THROMBOSIS represent?
Surgery
What does the ‘I’ in THROMBOSIS represent?
Immobilisation or iatrogenic factors (e.g., infected indwelling catheters, pacemaker wires)
What does the last ‘S’ in THROMBOSIS represent?
Serious illness
What are common presentations of pulmonary embolism?
- Sudden shortness of breath (SOB)
- Haemoptysis
- Palpitations
- Sharp chest pain, worse on inspiration
- Sweating
- Dizziness, fainting
- Anxiety
What does a CXR show in relation to pulmonary embolism?
CXR doesn’t show pulmonary embolism, but can be used to rule out pneumothorax and pneumonia.
What is the diagnostic scan for pulmonary embolism?
CTPA with lung window.
What blood test is used to rule out pneumonia?
Full Blood Count (FBC).
What test is performed for thrombophilia?
Coagulation screen.
What does an elevated D-dimer test indicate?
It is indicative of pulmonary embolism.
What scan is used if the patient is pregnant?
Ventilation/perfusion scan.
What ECG finding is associated with pulmonary embolism?
Sinus tachycardia.
What lab levels may be raised if pulmonary embolism is due to a cardiac cause?
Troponin and NT-proBNP levels.
What should be done while waiting for investigation results?
Do not delay management.
What scoring tool is used to measure the risk of mortality in pulmonary embolism?
Well’s score
What are the clinical features of deep vein thrombosis (DVT)?
Minimum of leg swelling and pain with palpation of the deep veins
What indicates that an alternative diagnosis is less likely than pulmonary embolism (PE)?
An alternative diagnosis is less likely than PE
What heart rate indicates a higher risk for pulmonary embolism?
Heart rate greater than 100 beats per minute
What recent medical history increases the risk of pulmonary embolism?
Immobilization for more than 3 days or surgery in the previous 4 weeks
What previous medical conditions are risk factors for pulmonary embolism?
Previous DVT or PE
What symptom related to the lungs is a risk factor for pulmonary embolism?
Haemoptysis
How does cancer treatment history affect the risk of pulmonary embolism?
Cancer (receiving treatment, treated in the last 6 months, or palliative)
What score range indicates that pulmonary embolism is unlikely?
0-4 points
What should be done if the D-dimer test is positive for a patient with low PE likelihood?
Do CTPA, if negative stop interim therapeutic anticoagulant
What score indicates that pulmonary embolism is likely?
More than 4 points
What is the immediate action for a patient with a high likelihood of pulmonary embolism?
Immediate hospital admission with immediate CTPA, give DOAC in the meantime
Management of pulmonary embolism without hypotension
DOACs such as warfarin or apixaban
Management of pulmonary embolism with hypotension
Systemic IV thrombolysis or catheter-directed thrombolysis
Management of pulmonary embolism without hypotension
DOACs such as warfarin or apixaban
Management of pulmonary embolism with hypotension
Systemic IV thrombolysis or catheter-directed thrombolysis
