Pulmonary Embolism

Question 1

What are the risk factors for a Pulm. Embolism?

Answer 1

Recent major trauma or surgery
Pregancy/Pill/HRT
Cardiopulmonary Disease e.g. an MI
Same risk factors for a DVT so long haul drive or flight or bedrest, hypercholesterolaemia, hypertension.
Inherited thrombophilia e.g. Factor V Leiden

Question 2

What are the symptoms of a PE?

Answer 2

Pleuritc Pain
Cough
Haemoptysis
Acute Dyspnoea
Massive PE: Syncope and Cardiac Arrest

Question 3

How do we investigate a PE?

Answer 3

With a pre-test risk analysis using the Wells or Geneva scores.

Then:
ECG
D-dimer + FBC + Biochemistry + ABG
CXR + CT Pulmonary Angiogram + Echocardiogram + V/Q Scan
~ CT abdomen, mammography and thrombophilia testing

Question 4

How do we treat PE?

Answer 4

O2

Anti-Coagulation:
Direct Oral Anticoagulant - Rivaroxaban
LMWH (2-3 days)
Warfarin (3-6 months)

Thrombolysis:

• For a massive acute PE
• Alteplase
• Contraindicated in bleeding, recent trauma or surgery

Embolectomy:

Vena Caval Filter:

Question 5

What are the signs of PE?

Answer 5

Fever
Pleural Rub
Stony Dullness to Percussion (Pleural Effusion)
Tachycardia
Tachypnoea
Hypoxia
Massive PE: Hypotension