Pulmonary embolism

Question 1

what are the risk factors

Answer 1

recent surgery, thrombophilia, leg fracture, prolonged bed rest/reduced motility, malignancy, pregnancy/postpartum, previous PE

Question 2

clinical features

Answer 2

acute breathlessness, pleuritic chest pain, haemoptysis, dizzy, syncope.

Question 3

signs

Answer 3

pyrexia, cyanosis, tachypnoea, tachycardia, hypotension, raised JVP, pleural rub, pleural effusion.

Question 4

tests

Answer 4

FBC, U&E, baseline clotting, D dimers (if negative then can exclude), ABG (low o2 and co2), imaging- CXR may be normal, ECG may be normal or tachycardia, RBBB,

Question 5

treatment

Answer 5

anticoag with LMWH. start warfarin. stop heparin when INR >2.

Question 6

what INR should you aim for

Answer 6

2-3

Question 7

when should you give thrombolysis

Answer 7

if a massive PE- give alteplase 10mg IV over 1 min then 90mg IVI over 2h

Question 8

prevention

Answer 8

give heparin (dalteparin) to all immobile patients. compression stockings. stop HRT and the pill if pre op.

Question 9

what is the recommended 1st line imaging

Answer 9

CTPA- to see if clots are in the pulmonary arteries