Pulmonary Embolism Flashcards
What is a pulmonary embolism (PE)?
A blockage of an artery in the lungs by a substance that has travelled from its site of origin.
What are the causes of a pulmonary embolism?
Venous thrombosis- clot from pelvis or legs breaks off and passes through veins and the right side the of the heart before lodging in the pulmonary circulation. RV thrombus post MI Septic emboli (right sided endocarditis) Fat Air Amniotic fluid etc
What are the risk factors of a pulmonary embolism?
Recent surgery Thrombophilia e.g antiphospholipid syndrome Leg fracture Prolonged bed rest/reduced mobility Malignancy Pregnancy/postpartum Previous PE
What are the clinical features of a PE?
Small one may be asymptomatic Symptoms: SOB Pleuritic chest pain Haemoptysis Dizziness Syncope Signs: Pyrexia Cyanosis Tachypnoea Tachycardia Hypotension Pleural effusion Increased JVP
What tests would you do for a suspected PE?
D-dimer FBC Baseline clotting ABGs (may show decreased PaO2 and CO2) U+Es CXR CTPA ECG
What is the Wells criteria?
It is a scoring system to assess the likelihood of a PE. If score is greater that 4 do a D-dimer.
If the d-dimer is positive do an immediate CTPA or LMWH
What variables are involved in the Wells criteria?
Clinical symptoms of DVT
HR>100
Recently bedridden> 3days
Previous DVT or PE
Haemoptysis
Cancer receiving active treatment or palliative
Alternative diagnosis is less likely than PE
How do you treat a PE?
Thrombolyse if haemodynamically unstable (alteplase 10mg IV over 1 min then 90mg over 2hrs)
LMWH and DOAC if haemodynamically stable
How can you prevent a PE?
Heparin for immobile patients
Stop HRT and COCP pre op
