Pulmonary Embolism

Question 1

Pulmonary Embolism: Define:

Answer 1

Blockage in the pulmonary artery (vessel that carries blood from the heart to the lungs)
From lower limb DVT: blood clot in deep leg veins break off & go to the pulmonary arterial circulation.
Causes hyperventilation, drop in arterial carbon dioxide partial pressure & respiratory alkolosis.

Question 2

Pulmonary Embolism: Risk Factors:

Answer 2

Previous Pulmonary Embolism 
Prolonged bed rest
Pregnancy 
Hormone Replacement Therapy 
Leg Fracture 
Recent Surgery 
Thrombophilia

Question 3

Pulmonary Embolism: Symptoms:

Answer 3

Acute breathlessness
Pleuritic Chest Pain 
Haemoptysis
Pre-syncope
Scared
Cough
- if massive Pul Emb:
sudden chest pain
breathlessness
syncope 
low BP
Do -> surgery - Thrombolysis - ECG

Question 4

Pulmonary Embolism: Signs

Answer 4

Pyrexia (45%)
Pleural Rub
Pleural Effusion 
Hypoxia
Cyanosis 
Hypotension 
Unwell
Tachycardia
Tachypneoa 
Rasied JVP
Dullness on Percussion

Question 5

Pulmonary Embolism: Investigations:

Answer 5

Wells Score
Arterial blood gas ABG (low paO2, low paCO2)
CT Pulmonary Angiography (not in renally impaired)
CXR - oligaemia, dilated pulmonary artery, linear atelectasis, small pleural effusion or cavitation
ECG - tachycardia, right bundle branch block, right ventricular strain
D Dimer
Increased Troponin
V/Q Scan - diagnosis (if delay in starting scan - treat with LMW-heparin)

Question 6

Pulmonary Embolism: Diagnosis:

Answer 6

Ventilation/Perfusion V/Q Scan: 
Inhalation of radioactive Xenon gas
Look for V/Q mismatch 
\+ = treatment     - = no treatment
Low/Intermediate probability do ECG.

Question 7

Pulmonary Embolism: Treatment

Answer 7

Low molecular weight Heparin
Oxygen
Thrombolysis (Alteplace 10mg Iv 1 minute, 90 mg IV 2 hours)
Inferior Vena Caval Filter IVC
Analgesia
Supportive - prevention, resusc, respiratory support (ventilation) haemidynamic support,
Warfarin for 3-6 months post PE (blood thinning reduces risk of reoccurring)
Direct Oral Anticoagulant
Pulmonary Embolectomy Surgery

Question 8

Pulmonary Embolism: Preventative Treatment

Answer 8

Heparin - to all imobile patients
Compression stockings
Stop Hormone Replacement Therapy HRT & Oral Contraceptive Pre-Op