Pulmonary embolism

Question 1

What type of embolism is a pulmonary embolism?

Answer 1

Thromboembolism

Question 2

Where does the thrombus usually arise from in pulmonary embolism?

Answer 2

Deep vein in leg

particularly the popliteal vein, iliac veins

Question 3

What is the name of the condition of a thrombus in a deep vein in the leg?

Answer 3

Deep vein thrombosis (DVT)

Question 4

How does a small pulmonary embolism present?

Answer 4

Asymptomatic

Question 5

How do multiple small pulmonary emboli present?

Answer 5

Pulmonary hypertension

Right ventricular failure

Question 6

Why do multiple small pulmonary emboli cause pulmonary hypertension?

Answer 6

Block pulmonary arteries

increases pressure in pulmonary arteries

Question 7

Why do multiple small pulmonary emboli cause right venticular failure?

Answer 7

Right ventricle has to contract harder to generate higher pressures to push blood through pulmonary circulation
suffers volume overload

Question 8

How do large pulmonary emboli present?

Answer 8

Pleuritic chest pain

Dyspnoea

Pleural rub

Raised JVP

Question 9

What investigations are done when a patient is suspected to have a pulmonary embolism?

Answer 9

Chest X-ray

ECG

Blood gases

D-dimer

CT scan

Question 10

What does a chest X-ray of a patient with a pulmonary embolism look like?

Answer 10

Normal

Question 11

What does an ECG of a patient with a pulmonary embolism look like?

Answer 11

Right chest leads - T wave inversion

S1 Q3 T3

Question 12

What is S1 Q3 T3?

Answer 12

Lead 1 - deep S wave

Lead 3 - deep Q wave, inverted T wave

Question 13

What are the levels of blood gases of a patient with a pulmonary embolism?

Answer 13

Hypoxia

Hypocapnia

Question 14

Why do patients with pulmonary embolism have hypocapnia?

Answer 14

Respiratory alkalosis

due to hyperventilation

Question 15

What are the levels of D-dimers in the blood of a patient with a pulmonary embolism?

Answer 15

Patient who’s never had a pulmonary embolism before - raised

Patient who’s had a pulmonary embolism before - normal or raised

Question 16

How are pulmonary embolisms treated?

Answer 16

For all patients, oxygen immediately

For all patients, IV heparin immediarely

Only for high risk patients

• fibrinolytics
• thrombectomy, embolectomy

For all patients, oral anticoagulents or IVC filter long-term

Question 17

How does immediate IV heparin treat a pulmonary embolism?

Answer 17

Stops the propogation of the thrombus in the pulmonary artery and also the source

Question 18

What are some examples of fibrinolytics?

Answer 18

Streptokinase

Tissue plasminogen activator

Question 19

How are fibrinolytics given?

Answer 19

IV

directed to pulmonary artery embolism by a percutanenous catheter

Question 20

What is an example of an oral anticoagulant?

Answer 20

Warfarin

Question 21

How long are patients who had a pulmomary embolism given oral anticoagulants for?

Answer 21

3 months if there was an identifiable risk factor

Forever if there was no identifiable risk factor, or if they have cancer

Question 22

What is an IVC filter?

Answer 22

Filter in the IVC that presents the passage of thromboemboli from the lower body up to the heart

Question 23

When is an IVC filter given to a patient who had a pulmonary embolism?

Answer 23

If they can’t be given anticoagulants

Question 24

What is a paradoxical embolus?

Answer 24

Embolus passes from right atrium, through patent foramen ovale, into left atrium

Question 25

What does a paradoxical embolus most commonly cause? How?

Answer 25

Stroke

travels from left atrium to blood vessel supplying the brain

Question 26

How does a pulmonary embolism affect ventilation:perfusion?

Answer 26

Causes ventilation:perfusion mismatch

because alveoli are ventilated but not perfused

Question 27

What is a saddle embolus?

Answer 27

Pulmonary embolism that lodges in the bifurcation of the pulmonary artery