Pulmonary Embolism Flashcards
What are the S and S of pulmonary embolus?
Pleuritic chest pain i.e. Worse on deep inspiration.
Pain can radiate to shoulder, jaw, neck or arm.
Shortness of breath
Dyspnoea
Tachypnoea greater than 20
Tachycardia greater than 100
SPO2 less than 92%
Wheezing
Cough
Poss haemoptysis
Apprehension
Leg - unilateral swelling, warm, red, pain on palpation
Massive PE = shock symptoms i.e. low BP, cyanosis etc.
Syncope
What are differential diagnoses for pulmonary embolus?
ACS
Chest infection
Pleurisy
Hysterical hypoventilation
How strong is the link between DVT and PE?
70% of patients with PE have associated DVT.
Although recommended, why is calf assessment limited with regard to diagnosing PE?
Many serious/massive pulmonary emboli originate in the large vessels if the thigh.
What are the risk factors for PE?
Long haul travel Sedentary due to injury/illness Obesity Pregnancy Birth control pill HRT Older patients Surgery (last 4 weeks) Clotting disorder Hx of clots Recent lower limb fractures Recent AMI Bed rest greater than 3 days Neurological disease with extremity paresis. Cancer treatment within 6 months or palliative care.
Can PE present with progressive onset?
Yes, if multiple small emboli present. Sudden onset with large clots.
What is the mortality rate for PE?
7-11%
What is the most common ECG rhythm with PE?
Sinus tachycardia. S1Q3T3 is rare ( 10%)
Large S wave in lead I
Q wave in lead III
Inverted T wave in lead III
Which regard to calf diameter, what is a red flag?
Difference of 3 cms or more.
What is the treatment for PE?
Position for comfort and ease of respiration. O2 for 94-98% 12 lead Prepare for CPR Fluids if indicated Pre-alert/blues
What hx is pertinent with regard to PE?
Have they had recent surgery, pregnant, prolonged immobilisation.
