Pulmonary Embolism

Question 1

What causes PE’s?

Answer 1

90% come from DVT’s from lower leg

10% from pelvis or above the SVC

Question 2

What are the hereditary risk factors for PE?

Answer 2

1. Factor V leiden
2. Activated protein C resistance
3. Protein C deficiency
4. Protein S deficient

Question 3

What are medical risk factors for PE?

Answer 3

Congestive Heart Failure (CHF)
MI
CVA
Atrial Fibrillation
COPD

Question 4

What is the classic triad presentation of PE?

Answer 4

1. Hemoptysis
2. Dyspnea
3. Chest pain

Question 5

What are common symptoms of PE?

Answer 5

Dyspnea, pleuritic pain, cough, calf pain/swelling, thigh swelling, wheezing

Question 6

What are common signs of PE?

Answer 6

Tachypnea
Tachycardia
Rales

Question 7

What is the gold standard of diagnostic imaging tests for PE?

Answer 7

Pulmonary Angiography

Question 8

Describe what you see on CXR in patient’s with a PE

Answer 8

Almost always normal
–> 24-72 hrs after atelectasis and alveolar infiltrates develop making it indistinguishable

Rare findings:

• Westermark’s sign
• Hampton’s Hump

Question 9

Treatment for PE’s

Answer 9

Anticoagulants (warfarin/coumadin, low molecular weight heparin)

Question 10

If a patient had a massive PE what tx would work best?

Answer 10

Thrombolytics

–> don’t give if recent surgery, current anticoagulation, current GI bleed

Question 11

Why does warfarin/coumadin need constant testing?

Answer 11

Narrow therapeutic range

INR is between 2-3