Pulmonary Embolism Flashcards
Pulmonary Embolism: Define
Pulmonary Embolism is a blockage in the pulmonary artery. The majority of PEs arise from the propagation of the lower limb DVT; blood clots from legs deep veins and break off to the pulmonary arterial circulation.
Pulmonary Embolism Risk Factors:
Previous PE Prolonged Bed Rest Pregnancy HRT Leg Fracture Recent Surgery Thrombophilia
Pulmonary Embolism: Symptoms
Acute Breathlessness Pleuritic Chest Pain Pre-Syncope Cough Haemoptasis Scared? If massive PE = sudden chest pain, breathlessness, collpase, low BP Do surgery - Thrombolysis, ECG.
Pulmonary Embolism: Signs
Pyrexia Pleural Rub Pleural Effusion Hypoxia Hypotension Unwell Tachypnoea Tachycardia Raised JVP Dullness on Percussion Cyanosis
Pulmonary Embolism: Investigations:
Wells Scoring System
ABG (low PaO2, low PaCO2)
CT Pulmonary Angiography CTPA (diagnosis)
CXR (normal, or oligameia of affected segment, dilated pulmonary artery, linear atelectasis, small pelural effusion, or cavitation)
ECG (normal, tachycardia, right bundle branch block, right ventricular strain)
D Dimer
Increased Troponin
V/Q Scan
Pulmonary Embolism: Diagnosis: V/Q Scan
Inhalation of Radioactive Xenon Gas
Inhalation of Technetium Radiolabelled Albumin
Look for V/Q mismatch
Positive scan = treat, Negative = don’t treat
Low and Intermediate probability, then further investigation via ECG.
Pulmonary Embolism: Treatment:
Low molecular weight Heparin
Oxygen
Thrombolysis = Alteplase = 10mg IV over 1 min, then 90mg IV over 2 hrs
Inferior Vena Caval Filter
Analgesia
Supportive = Prevention, Resus, Resp support, Haemodynamic support, Warfarin
DOAC
Pulmonary Embolectomy Surgery
Anticoagulation lmwH, Warfarin, reduces PE from recurring, as it thins blood.
The blood thinning duration is 3-6 months with Warfarin
Pulmonary Embolism: Prevention:
Heparin - give this to immobile patients
Compression stockings
Stop HRT and Oral Contraceptive pre-op.
