Pulmonary Embolism Flashcards
Define pulmonary embolism. (3)
An obstruction of a pulmonary artery one one of its branches usually by a blood clot which has become dislodged and carried to the lungs by the bloodstream.
Describe the consequences of pulmonary embolism. (5)
Affected segments of lungs aren’t perfused: blood is redirected, p(O2) drops, hyperventilation occurs.
Rise in pulmonary artery pressure leads to increased right ventricular strain and lowered cardiac output.
Lung infarction (rare)
Describe 9 factors that increase the likelihood of a PE in order of most likely to least likely.
Pregnancy Immobilisation Contraceptive pill Long haul travels Cancer Heart failure Obesity HRT Smoking.
Describe the symptoms of a PE. (7)
Dyspnoea, pleuritic chest pain, cough, fever, haemoptysis, syncope, unilateral leg pain.
Describe signs of a PE. (4)
Tachycardia, hypotension, pleural rub, raised JVP.
Describe other differentials for PE. (6)
Pneumothorax Pneumonia Pleurisy MSK chest pain MI Pericarditis
Describe the investigations you would undergo for a PE. (8)
Blood gases - hypocapnia, hypoxia, respiratory alkalosis.
Chest x Ray to rule out differentials
ECG - right ventricular strain can lead to S wave in I, Q wave in III and inverted T in III > S I, Q III, T III.
D-dimers - normal rules out PE.
CT pulmonary angiography.
Describe treatments for PE. (6)
Oxygen Immediate heparinisation to stop propagation Haemodynamic support Exogenous haemolytics to dissolve clot Thrombectomy Pulmonary embolectomy.
Describe the long term treatments for PE. (3)
Oral anticoagulants: 3 months if temporary risk (pregnancy, travel) or indefinitely (cancer, unknown cause). IVC filter (rare).
