Pulmonary Embolism

Question 1

What is it?

Answer 1

A medical emergency in which a blood clot or embolus obstructs the Pulmonary Artery tree so blood cannot supply one of the lungs

Question 2

What causes it? (5)

Answer 2

1. Thrombosis usually from a distant vein e.g DVT
2. Fat embolus usually seen following long bone fracture
3. Amniotic fluid seen in pregnancy
4. Air following neck vein cannulation or bronchial trauma
5. Foreign body seen in IVDU

Question 3

Are they common?

Answer 3

Not really, affect 1 per 1000 people per year

Question 4

Risk factors (10)

Answer 4

Recent surgery (abdominal/pelvic or orthopaedic), Thrombophilia, leg fracture, prolonged bed rest or immobility, malignancy, obesity, pregnancy, COCP, HRT, previous episode

Question 5

Symptoms (5)

Answer 5

Dyspnoea, pleuritic chest pain, cough, haemoptysis, any leg symptoms

Question 6

Signs (8)

Answer 6

Tachypnoea, tachycardia, hypoxia, pyrexia, raised JVP, gallop heart rhythm, pleural rub, hypotension

Question 7

Differentials (5)

Answer 7

ACS, Aoritc dissection, Musculoskeletal, Pneumonia, Pneumothorax

Question 8

What bloods would you do? (7)

Answer 8

Clotting and D-Dimer, FBC, LFT, Serum Calcium, ABG, Cardiac Troponins

Question 9

Other investigations (8)

Answer 9

Chest xray, CT pulmonary angiogram, Ultrasound, VQ Spect scan (isotope lung scan), Urinalysis, ECHO, ECG, Leg ultrasound

Question 10

What score is used for P.E?

Answer 10

WELLS Score

Question 11

What does the wells score mean? (7)

Answer 11

1. Clinical signs and symptoms of DVT
2. P.E is first clinical diagnosis
3. Heart rate >100
4. Recent immobilisation or Surgery
5. Previous episode
6. Haemoptysis
7. Malignancy

Question 12

Treatment (7)

Answer 12

Oxygen therapy, IV access, Analgesia e.g Morphine, Thrombolysis e.g 50mg bolus Alteplase/LMWH or Fondaparinux, LMWH for 5 days, Long term warfarin therapy, May need surgical clearance of thrombus if massive

Question 13

Complications (2)

Answer 13

untreated P.E has a poor prognosis, Chronic Thromboembolic Hypertension leading to heart failure,

Question 14

Is there a good prognosis?

Answer 14

Mortality rate is low in haemodynamically stable patients, mortality at 3 months from a P.E is 17%

Question 15

How can we prevent it?

Answer 15

Early post-operative mobilisation, compression stockings, LMWH prophylaxis, avoid COCP before major surgery, anticoagulation