Pulmonary embolism Flashcards
Explain what a pulmonary embolism is to a patient
A pulmonary embolism is a sudden blockage of the pulmonary arterial system, by one or more emboli, usually arising from a blood clot in the leg.
This results in reduced gas exchange, of the affected lung tissues, causing hypoxaemia and a reduction in cardiac output.
Large emboli can cause syncope, hypotension, shock and sudden death
What are the symptoms of a PE?
Dyspnoea
Tachypnoea
Haemoptysis
Chest pain (sharp, pleuritic pain - worse on coughing/breathing)
DVT symptoms
(Pain, swelling, tenderness in one leg, heavy ache, warm red skin)
Others:Cough, syncope, tachycardia, Palpitations
How is the Well’s score calculated?
+ 3 = Clinical symtpoms of a DVT
= PE is number one diagnosis
+1.5 = Heart rate> 100bpm
= immobolisation (>3days)/ surgery (<4wks ago)
= Previous diagnosed PE/ DVT
+ 1 = Haemoptysis
= malignancy with/without treatment within 6mths
= Palliative care
What are the risk factors for a DVT/ PE?
Inactivity for long periods REcent surgery to legs, hips, abdomen or brain Cancer, HF, stroke, severe infection Pregnancy/childbirth OCP/HRT Smoking Age (>70) Obesity Previous DVT/PE
How is a PE diagnosed?
- History
- Examination - Assess legs for DVT
- Calculate wells score
- CT pulmonary angiogram
(*would do D-dimer after wells score if low risk but still suspecting)
Others: ABG CT/ MRI Doppler USS Troponin (rule tout MI) BNP (Heart stress?) Echo - enlarged right ventricle indicates a PE
What causes a PE?
70-80% of PE’s are caused by a DVT (embolus breaks off and travels to the lungs), but only 15% of people with a PE had signs of a DVT before the PE presented.
Other causes: Amniotic fluid Air bubbles Tumour Fat (Released when bone breaks)
How is a PE treated?
High wells score —-> CT PA and anticoagulants
Low wells score —-> D-Dimer
Low D-Dimer—> Other Dx
High D-Dimer—> CTPA/ Anti-coag
Anticoagulants used:
LMW heparin e.g. Dalteparin, Enoxaparin
Fondaparinux
