pulmonary embolism Flashcards
risk factors for pulmonary embolism
immobility
recent surgery
long-haul travel
pregnancy
oestrogen
malignancy
polycythaemia
SLE
thrombophilia
what is used for VTE prophylaxis
low molecular weight heparin (enoxaparin)
unless contraindicated
when are anti-embolic compression stockings contraindicated
peripheral arterial disease
presentation of PE
SOB
cough
haemoptysis
pleuritic chest pain
hypoxia, tachycardia, raised resp rate, fever
signs of DVT
what is PERC
done when there is a low chance of PE
all criteria must be absent to have negative result
what is included in well’s score
clinical signs and symptoms of DVT
an alternative diagnosis is less likely than a PE
HR > 100
immobilisation for more than 3 days or surgery in the previous 4 weeks
previous DVT/PE
haemoptysis
malignancy
Well’s score cut offs
> 4 points PE likely
< 4 PE unlikely
next step if Well’ score positive
arrnage immediate CT PA
- give therapeutic anticoag if delay in getting scan (apixaban or rivaroxaban)
next step if well’s socre 4 <
arrange D-dimer
if positive -> CTPA
if negative -> stop anticoag and consider different diagnosis
ECG changes seen in PE
large S wave in lead I
large Q wave in lead III
inverted T wave in lead III
S1Q3T3
right BBB and right axis deviation also
ABG results in PE
respiratory alkalosis
blow odd extra CO2 -> low CO2 means blood is alkalotic
also have a low pO2 (differentiate from hyperventilation)
management of PE
supportive management
anticoag: apixaban or rivaroxaban (first line), LMWH is alternative
how to treat massive PE with haemodynamic compromise
continuous infusion of unfractionated heparin and consider thromblysis
how long to continue anticoagulant for
provoked PE: 3 months
unprovoked PE, recurrent VTE or irreversible cause: beyond 3 months
active cancer: 3-6 months
