PULMONARY EMBOLISM

Question 1

What is a pulmonary embolism?

Answer 1

• obstruction with in the pulmonary arterial tree

Question 2

What is the obstruction in PE usually caused by?

Answer 2

-emboli

Question 3

What types of emboli are there? (4)

Answer 3

• thrombosis
• fat
• amniotic fluid
• air

Question 4

Where does a thrombus in the lung usually arise from and how does it travel to the lung? (2)

Answer 4

• a distant vein in the leg

- via the venous system

Question 5

When does a fat emboli form? (2)

Answer 5

• following a long bone fracture

- following orthopaedic surgery

Question 6

When does an air emboli form? (2)

Answer 6

• neck vein cannulation

- bronchial trauma

Question 7

What causes a PE? (5)

Answer 7

• venous thrombus arises from the legs or pelvis
• clots breaks off
• clot passes through the veins
• travels to the right hand side of the heart
• and enters the pulmonary circulation

Question 8

What are the risk factors for PE? (8)

Answer 8

1. surgery - abdo, hip, pelvic, knee
2. thrombophillia
3. leg fracture
4. prolonged bed rest
5. reduced mobility
6. malignancy
7. pregnancy
8. previous PE

Question 9

What are the symptoms? (5)

Answer 9

1. acute breathlessness
2. pleuritic chest pain
3. haemoptysis
4. dizziness
5. syncope

Question 10

What are the signs of PE? (9)

Answer 10

1. pyrexia
2. cyanosis
3. tachypnoea
4. tachycardia
5. hypotension
6. raised JVP
7. pleural rub
8. pleural effusion
9. DVT

Question 11

Differential diagnosis (6)

Answer 11

1. acute coronary syndrome
2. aortic dissection
3. cardiac tamponade
4. pneumonia
5. pneumothorax
6. sepsis

Question 12

Investigations (7)

Answer 12

1. FBC
2. U&Es
3. Baseline clotting
4. D-dimers
5. ABG
6. CXR
7. ECG

Question 13

What would the ABG results show? (2)

Answer 13

• decreased PaO2

- decreased PaCO2

Question 14

What would the CXR show? (6)

Answer 14

• normal

or

• show oligaemia
• dilated pulmonary artery
• linear atelectasis
• small pleural effusion
• wedge shaped opacities

Question 15

What would the ECG show? (1 and 3)

Answer 15

• normal

or

• tachycardic
• right bundle heart block
• right ventricular strain

Question 16

What is the treatment? (5)

Answer 16

1. anticoagulants with LMWH
2. warfarin
3. thrombolysis
4. vena cava filter
5. stop any causes - pill, HRT

Question 17

What should you stop pre-operative and why? (2,1)

Answer 17

• pill
• HRT

-risk factor for PE