Pulmonary Embolism

Question 1

What is a pulmonary embolism?

Answer 1

Occlusion of pulmonary artery due to lodging of an embolism from a distant site, causing reduce perfusion of lung tissue.

Question 2

What are some typical types of emboli in a PE?

Answer 2

• Thrombus (>95% from DVT)
• Air
• Fat (recent bone fracture)
• Tumour

Question 3

4 Risk factors for a PE

Answer 3

• Recent surgery
• Active malignancy
• Immobility
• Recent trauma/fracture

Question 4

Symptoms of a PE

Answer 4

• Small: May be asymptomatic
• Moderate: Sudden onset dyspnoea and chest pain, cough, haemoptysis
• Large: Severe chest pain, collapse
• Multiple recurrent: Signs of right-sided heart failure, pulmonary oedema

Question 5

5 Signs of a PE

Answer 5

• Tachycardia
• Tachypnoea
• Pleural rub on ausculatation
• Decreased SaO2
• Raised JVP (large PE)

Question 6

How would you investigate a PE?

Answer 6

• ECG: Sinus tachycardia, S1Q3T3
• CXR: Clear - to rule out differentials
• Bloods: D-dimer
• VQ scan: good ventilation, poor perfusion
• Echo or CTPA: visualise thrombus
• ABG: hypoxia and hypocapnia

Question 7

How would you manage a patient with a PE?

Answer 7

For haemodynamically stable patients:

• Oxygen
• Analgesic
• Anticoagulant:
• –First give LMWH for 5-6 days until INR>2
• –Then give warfarin for 3 months

For haemodynamically unstable patients:

• Resus
• Oxygen 60%
• IV fluid resus
• Analgesia
• tPA

Question 8

Possible complications of a PE

Answer 8

• Right-sided heart failure
• Pulmonary hypertension
• Cardiac arrest