[pulmonary embolism] Flashcards
pelvis
leg
pulmonary circulation
right ventricular thrombus
right sided infective endocarditis
surgery thrombophilia malignancy pregnancy/pill/HRT prolonged rest
pyrexial pleural rub tachypnoea cyanosis raised JVP hypotensive
ECG
CXR
ABG
tachycardia
right bundle branch block
right ventricular strain
(or normal!)
oligaemia of affected segment dilated artery linear atelectasis wedge shaped cavities small pleural effusion
reduction in blood volume
minimal degree of collapse cf. lobular atelectasis
to the lungs
inflamed pleural surfaces rubbing together
low PaCO2
low PaO2
hyperventilation + poor gas exhange
PE occurence (many causes of raised D-Dimer)
there is no PE
i.e. high sensitivity low specificity
CTPA (CT pulmonary angiography)
LMWH
TED stockings (thromboembolic deterrent)
vena caval filters
contraceptive pill
LMWH (tinzaparin 175u/kg/24h SC)
OR
UFH 10,000 IU bolus IV (then IVI guided by APTT)
Warfarin 5-10mg PO (*if BP >90mmHg)
colloid infusion
colloid infusion
alteplase 50mg bolus
i.e. immediate thrombolysis
colloid infusion 500mL
Dobutamine 2.5-10ug/kg/min IV
b1 agonist - increased CO and increased renin release
combined contraceptive pill
b1 agonist - increased CO and increased renin release
minimum of 3 months
Wells
an alternative Dx is likely or more likely than DVT
cancer within last 6 months lower limb immobility major surgery in last 4 weeks/bed ridden >3days localised tenderness along veins entire leg swollen increased calf circumference >3cm pitting oedema in asymptomatic leg collateral superficial veins alternative Dx likely (-2)
1-2
> =3
there is no PE
i.e. high sensitivity low specificity
high (>=3)
0
imaging (CTPA)
+ D-Dimer test
high clinical probability (Wells score)
yes if high clinical risk (Wells score)
+ D-Dimer test
no
noradrenaline IV
circulatory collapse
hypotensive, raised JVP
