Pulmonary Embolism Flashcards
What can make up a pulmonary embolus?
Thrombus
- often from DVT/groin
Fat
- bone fracture
Amniotic
- pregnancy
Air
Risk factors for pulmonary embolism
Pregnancy Immobilization Previous VTE Contraceptive pill Cancer Obesity
Pathophysiology of pulmonary embolism
Right ventricular overload
- increase in pressure in pulmomary artery
- right ventricular dilatation and strain
Respiratory failure
- areas of V/Q mismatch
- Low right ventricle output
Pulmonary infarction
- alveolar haemorrhage
Symptoms of PE
Cough
Dyspnoea
Pleuritic chest pain
Signs of PE
Tachycardia
Tachypnoea
Pyrexia
Differential diagnoses of PE
Pneumothorax Pneumonia Pleurisy Musculo-skeletal chest pain MI Pericarditis
Investigations for a suspected PE
Bloods
- FBC
- U&Es
- Coagulation
- troponin
ABG - hypoxaemia + hypocapnia
CXR - exclude other diagnoses
ECG - S1Q3T3
Classification of PE
Massive = <90 systolic BP Submassive = RV dysfunction Non-massive = no severe symptoms
What is PE Wells Score?
Objectifies risk of PE
>4 = PE likely = = PE unlikely
What is PERC?
PE rule out criteria
Management of PE
ABCDE O2 Analgesia IV Heparin tPA (streptokinase/alteplase)
When is thrombolysis used?
Massive/submassive PE
What are the X-ray changed in PE?
Mostly normal
Fleischner sign = enlarged pulmonary artery
Hampton hump = peripheral wedge of airspace opacity - lung infarction
Knuckle sign = abrupt tapering of pulmonary artery
What are the ECG changes in PE?
Most commonly = sinus tachy
Right heart strain
- RBBB
- right axis deviation
S1Q3T3
- lead 1 = deep s wave
- lead 3 = q + t wave inversion
