Pulmonary Embolism Flashcards
What are D-dimers?
D-dimers are cross-linked fibrin derivatives formed when fibrin is degraded by plasmin
What causes a positive D-dimer result?
PE MI Pneumonia Sepsis Cancer Pregnancy NOT SPECIFIC FOR PE
Is a positive D-dimer result diagnostic of a PE?
NO
A negative value excludes PE as a diagnosis
How can the clinical probability of PE be estimated?
Two-Level Wells Score
PE likely- more than 4 points
What do you do if a patient is suspected to have a PE and scores more than 4 on the Wells Score?
Immediate CTPA or
Immediate parenteral anticoagulant therapy followed by CTPA if CTPA cannot be carried out immediately
What to do if a patient is suspected to have a PE and scores less than 4 on the Wells Score?
D-dimer test and if positive
Immediate CTPA or
Immediate parenteral anticoagulant therapy followed by CTPA if CTPA cannot be carried out immediately
What can embolise to the lung?
Tumour Fat Amniotic Fluid Parasites Air Injected material Venous thrombosis
Symptoms?
Pleuritic pain, shapr, worse on inspiration, no radiation
ECG Changes
Sinus tachycardia RBBB Right axis deviation T wave inversions- V1-V4, II,III,aVF S1Q3T3
Chest X-ray findings?
None
Consequences of PE
Hypoxia- V/Q mismatch
RVF
Risk factors for PE
Malignancy Surgery Immobility Combined oral contraceptive pill Previous PE
ABG findings
Hyperventilation and poor gas exchange
PaO2 decrease
PaCO2 decrease
pH often Increase
Management
Compression Stockings
Oxygen
LMWH concurrently with warfarin until INR>2
6 weeks warfarin
Prevention
Antithromboembolic stockings
LMWH prophylaxis
Avoid contraceptive pill if at risk
