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RM - Resp Conditions Profiles > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

1
Q

What is the primary cause of pulmonary embolisms?

A

Thrombus from systemic veins

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2
Q

Where do <10% of the thrombi for pulmonary embolisms come from?

A

Right heart

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3
Q

What is the origin of the majority of thrombi that cause PEs?

A

DVTs from the pelvis or legs

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4
Q

What are the 3 components of Virchow’s Triad?

A

Hypercoaguable state
Endothelial injury
Circulatory status

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5
Q

What are the 4 other causes of PEs (other than a thrombus)

A

Fat
Tumour
Amniotic fluid
Foreign material

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6
Q

What is the common cause of a fat emboli?

A

Long bone fractures

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7
Q

What are the 2 types of risk factors for a PE?

A

Exposing and predisposing risk factors

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8
Q

What are exposing risk factors for PEs?

A

Acute conditions or trauma/surgery

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9
Q

Describe predisposing risk factors for PEs

A

Patient medical conditions that generally inhibits normal circulation

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10
Q

What are 5 examples of predisposing risk factors?

A 
Age
Obesity
CHF
Immobility
Pregnancy
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11
Q

What are the 4 key risk factors for a PE?

A

Surgery
Malignancy
Pregnancy
Clotting Abnormality

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12
Q

When does the contraceptive pill become a greater PE risk factor?

A

When it combined with smoking

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13
Q

What does a PE mean in terms of ventilation and perfusion of the lung tissue?

A

The tissue is ventilated but not perfused

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14
Q

After a few hours of lung tissue not being perfused, the production of ____ stops

A

Surfactant

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15
Q

What is the consequence of surfactant not being produced in infarcted lung tissue? (2)

A

Alveolar collapse and therefore worsening of hypoxia

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16
Q

Why does a PE cause an decrease in cardiac output?

A

There is a reduced pulmonary blood flow and an elevated pulonary arterial pressure

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17
Q

What does the clincal presentation of a PE depend on?

A

The size of the embolism

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18
Q

What are the 4 clincial presentations of a Massive PE?

A

CV shock
Low BP
Central cyanosis
Sudden death

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19
Q

What are the 3 symptoms of a medium PE?

A

Pleuritic pain
Haemotysis
Breathlessness

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20
Q

What are the 3 symptoms of small, recurrent PEs?

A

Progressive dysponea
Pulmonary hypertension
Right cardiac failure

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21
Q

What are the 2 clinical findings of a PE?

A 
Pleural rub (Localised)
Coarse crackles
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22
Q

What kind of resp failure are PE patients normally in?

A

Type one

Low PaO2 and SaO2

23
Q

What is the normal CXR finding of a PE?

A

Normal (especially early on)

24
Q

What are the 3 possible CXR signs of a PE?

A

Basal atectasis (collapse)
Consolidation
Slight pleural effusion

25
Q

What is an indicative, but very rare sign of a PE on a CXR?

A

Wedge shaped infarct

26
Q

What is the classic ECG presentaiton of a PE?

A

S1 T3 Q3 - Rare to see this

S wave in I, inverted T wave in III and Q waves in III

27
Q

What are the 3 more common ECG signs of a PE?

A

Tall P wave in II
RBBB
T wave inversion
(on right pre-cordial leads)

28
Q

What test is used to rule out a PE?

A

D-dimer

If negative, not PE

29
Q

What kind of imaging can be used to detect small, peripheral emboli?

A

Isotope lung scan (V/Q scan)

30
Q

What is the more accurate, and commonly used imaging in PE diagnosis?

A

CTA (CT pulmonary arteries)

31
Q

What is able to detect pulmonary artery filling defects?

A

CTA

32
Q

What imaging can best identify larger clots causing PEs?

A

CTA

33
Q

What is a test that can be done to determine the cause of a PE?

A

Ultrasound of the legs and pelvis - look for a DVT

34
Q

What feature on an ECG is inkeeping with a PE?

A

RV dilation

35
Q

Initially, what needs to be clarified/determined in the treatment of PEs?

A

Whether it is high risk or ‘non-high’ risk

36
Q

What 2 things must be present for a PE to be classed as high risk?

A

Shock or hypotension

37
Q

If a PE is deemed high risk, what is the imaging used to confirm the diagnosis?

A

CTA

38
Q

What needs to be done to determine the treatment of non-high risk PEs?

A

Well’s score - determines the probability of a PE

39
Q

What Well’s score is needed to make a PE likely?

A

= 4

40
Q

What are the 7 components of the Well’s scoring system?

A 
Clinical signs of DVT
PE most likely DDx
HR >100
Immobilisation for 3 days/surgery within 4 weeks
PMHx of DVT or PE
Haemotpysis
Malignancy within 6 months
41
Q

If the Well’s score deems a PE likely, what is the next course of action?

A

CTA to confirm diagnosis

42
Q

If the Well’s score deems a PE unlikely, what should be done?

A

A D-dimer

43
Q

What are the 3 main components of the acute management of a PE?

A 
High flow O2 (everyone except those with significant chronic resp disease)
IV fluids (improve right heart pumping)
Anticoagulation
44
Q

What are the 2 aims of the anti-coagulation in PE treatment?

A

Stop clot propagation

Tip body into thrombolysis state - able to break down clot itself

45
Q

What is the normal anti-coagulation therapy given in PE treatment?

A

Subcutaneous low molecular weight heparin

46
Q

What 2 things can be given instead of anti-coagulation?

A

Oral thrombin inhibitor (Dabigatran)
Or
Factor X inhibitor (Rivaroxaban)

47
Q

How long does it take for warfarin to antagonise the Vit K dependant prothrombin?
(I.e. for it to make an effect)

A

3 days

48
Q

When should the heparin be stopped post PE? (2)

A

3-5 days

INR>2

49
Q

When should warfarin be started in PE treatment?

A

At the same time as heparin

50
Q

What is the long-term treatment for a PE patient (duration)?

A

Warfarin

3-6 months

51
Q

What is the special/extra treatment given to those with life-threatening PEs?

A

Thrombolysis with tissue plasminogen activator (tPA) - i.e. tenecteplase

52
Q

What device can be fitted to stop PEs from happening again?

A

IVC filter

53
Q

What are the 4 key components to PE prevention?

A

Early post-op mobilisation
Compression stockings
Calf-muscle exercises
Subcutaneous, low dose LMWH perioperatively

RM - Resp Conditions Profiles (8 decks)

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