Pulmonary embolism Flashcards
1
Q
Causes
A
PE usually arises from a venous thrombosis in the elvis or legs. Clots break off and pass through the veins and the right side of the heart befre lodging in the pulmonar circulation
2
Q
Risk factors
A
- recent surgery
- thrombophillia
- leg fracture
- Prolonged bed rest
- malignancy
- previous PE
3
Q
Symptoms
A
- acute breathlessness
- pleuritic chest pain
- haemoptysis
4
Q
Signs
A
- Pyrexia
- cyanosis
- tachypnea
- tachycardia
- hypotension
5
Q
tests
A
- FBC, U&E, baseline clotting
- D-dimer- only perform in patients without a high probability of a PE. A negatve PE effectively excludes a PE in those with a low or intermediate clinical probabilit and imaging is NOT required. However, a positive test result does not prove and imaing is required
- imaging; 1st line CTPA!! CXR may be normal or show oligaemia of affected segment
- ECG
6
Q
ECG changes in PE
A
- Tachycardia
- R. axis deviation
- RBBB
- RV strain
- Deep S Waves in I
- Pathological Q waves in III
- Inverted T waves in III (SI QIII TIII)
7
Q
Risk assessment score
A
Modified geneva score - do before D-Dimer
8
Q
treatment
A
- ABC
- High flow oxygen
- IV ACCESS
- analgesia
- TED stockings
- anticoagulate with LMWH and start warfarin
- stop heparin when INR >2 and continue warfarin for a minimum of three months
- thromboylysis for massive PE (alteplase 1mg IV over 1 min)
9
Q
Prevention
A
- heparin - dalteparin to all immobile patients
- prescribe compression stockings
- early mobilization
- stop HRT and the pill
