Pulmonary Embolism Flashcards
What is a pulmonary embolism?
Pulmonary embolism (PE) is a life-threatening condition resulting from dislodged thrombi occluding the pulmonary vasculature
What is Virchow’s triad?
> Hypercoagulability
Stasis
Vessel wall injury
What are the types of embolus?
Fat Air Thrombus Bacteria Amniotic fluid Trauma
What are the signs and symptoms of PE?
Nonspecific signs
SOB
Pleuritic chest pain
Haemoptysis
What differentials might you have with a PE?
MI PNEUMOTHORAX AORTIC DISSECTION PNEUMONIA BOERHAAVE'S PERFORATION OF THE OESOPHAGUS
What Investigations would you do for PE?
CXR
Bloods
FBC
UE
Tropnin
Blood gas
ECG
sinus tachycardia
Right heart strain
Wells score for PE
D DIMER if PE is unlikely (not raised rules this out)
Scan lungs if PE likely
CTPA (ct pulmonary angiogram) [HIGH RADIATION]
V/Q scan looks at ventilation perfusion mismatch
US of legs for DVT
What is the management of a PE?
Assessment Stabilise high flow oxygen IV fluid Inotropic agents if needed Anticoagulate short term- LMWH Long term- warfarin or DOAC Cancer/ pregnancy- LMWH or DOAC IVC filter if needed
What are the symptoms of a massive PE?
hypotension
Syncope
Cyanosis
Cardiac arrest
What is the management of a massive PE?
ABCDE
ICU care
Emergency echo
Alteplase 100mg over 2 hrs (if haemodynamically unstable)
What are the complications of a PE?
Recurrence
Sudden cardiac death
Pneumonia on lung tissue that was infarcted
What is the prognosis of a PE?
Not good if not treated early
What are the risk factors of a PE?
> Age > DVT > Surgery > Immobility > Previos VTE/ FHx > Cancer > Pregnancy > Hypercoagulability (e.g. FV Leiden, deficiencies, antiphospholipid antibody syndrome)
