PULMONARY EMBOLISM

Question 1

WHAT IS A PULMONARY EMBOLISM?

Answer 1

Venous thrombosis in legs or pelvis (DVT) that breaks off and passes through right side of heart before lodging in pulmonary circulation.

Question 2

WHAT ARE THE RISK FACTORS OF PE?

Answer 2

1) Surgery - abdo, pelvis, knee/hip replacement
2) Obstetric
3) Reduced mobility
4) Previous PE
5) Contraceptive pill/ HRT

Question 3

WHAT ARE THE SYMPTOMS OF PE?

Answer 3

1) SOB
2) Pleuritic chest pain- sharp, when breathing
3) Haemoptysis
4) Syncope
5) Dizziness

Question 4

WHAT ARE THE SIGNS OF PE?

Answer 4

1) Tachycardia - >100 bpm
2) Hypotension
3) Tachypnoea - >20
4) Cyanosis
5) pleural effusion

Question 5

WHAT ARE THE INVESTIGATIONS FOR PE?

Answer 5

1) D-dimer with Wells score- negative test excludes PE, positive tests does not prove PE, imaging required
2) FBC- anaemia
3) Computed tomographic pulmonary angiography
4) Urea and electrolyte- anticoagulants can impair renal function
5) LFT’s
6) ABG

Question 6

WHAT IS THE MANAGEMENT OF PE?

Answer 6

1) Oxygen - if hypoxic
2) Fluid resuscitation - if hypotensive, 500 ml hartmanns
3) Unfractionated heparin then start thrombolysis (alteplase). Switch to LMWH after thrombolysis treatment.

Question 7

WHAT IS THE MANAGEMENT OF A MASSIVE PE?

Answer 7

1) IV alteplase (10mg) - thromblytic

Question 8

WHAT IS THE MAIN INDICATION OF MASSIVE PE?

Answer 8

hypotension

Question 9

HOW CAN YOU PREVENT PE’S?

Answer 9

1) Compression stockings
2) Prophylaxis heparin (dalteparin) to immobile patients
3) Stop HRT and pill pre-op
4) Early post-op mobilisation

Question 10

WHAT ARE THE DIFFERNTIAL DIAGNOSIS FOR A PE?

Answer 10

1) Lung cancer
2) Pneumonia
3) Acute MI
4) Pneumothorax
5) Asthma
6) COPD

Question 11

WHAT IS THE GOLD STANDARD INVSTIGATION FOR PULMONARY EMOBLISM?

Answer 11

CT pulmonary angiography

Question 12

WHAT IS THE ALTERNATIVE INVESTIGATION FOR PREGNANT WOMEN?

Answer 12

VQ scan

Question 13

WHAT IS THE MEDICATION FOR AN ACUTE PE?

Answer 13

• LMWH before any imaging to prevent deterioration

Question 14

WHAT ARE THE ECG FINDINGS FOR PE?

Answer 14

• sinus tachycardia
• right ventricular heart strain
• new right BBB
• S3T3Q3

Question 15

WHAT ARE THE ABSOLUTE CONTRAINDICATIONS FOR THROMBOLYSIS?

Answer 15

• Haemorrhagic stroke or Ischaemic stroke < 6 months - CNS neoplasia
• Recent trauma or surgery (the hip replacement surgery was not recent)
• GI bleed < 1 month (malaena would indicate an upper GI bleed)
• Bleeding disorder
• Aortic Dissection