Pulmonary Embolism Flashcards
Normal V/Q scan and any pretest probability of PE
PE excluded
Low probability V/Q scan and low pre test probability of PE
PE excluded
High probability (for PE) V/Q scan and high pre test probability of PE
PE confirmed
all other combinations of V/Q and pre test probabilities
need additional testing to make a call (CTA or LE u/s)
Massive PE is
hypotension with SBP<90 or drop in SBP of >40 for >15 minutes
What is the best way to confirm hemodynamically unstable pt who may have a PE?
bedside TTE for right ventricular overload.
can people who have anaphylaxis with seafood or serious seafood allergies get iodinated radiocontrast?
yes. and people who get CT with iodinated contrast do not need pretreatment with steroids or antihistamines.
can people who have anaphylaxis to iodinated contrast eat seafood
yes. There is no cross over with iodinated contrast and seafood.
why do we avoid high osmolar radiocontrast
increased rates of allergic reactions and contrast induced nephropathy
V/Q scan is meant for pts with suspected PE who have
renal insufficiency, true contast allergy or those who have inconclusive CTPA.
Initial test of choice for pregnant women with normal CXR.
who gets long term aspirin after a VTE?
unprovoked VTE in whom anticoagulation is discontinued start aspirin
shown to reduce risk for recurrence PE by 30-40%
Modified PESI score for out patient treatment of VTE:
pts <80 yrs
no significant comorbidity
HR<110/min
SBP>100
oxygen saturation >90 on RA
low risk for bad outcomes
if someone has established PE, do they need routine duplex imaging of lower extremities?
no.
if someone has acute DVT do they need a CT angiography to look for PE?
no. Get a TTE to evaluate for acute pulmonary artery hypertension and right ventricular strain that may signify massive PE
get serial troponins and BNP to help categorize
treatment of massive PE and shock
thrombolytic therapy is better than traditional anticoagulative.
thrombolysis for DVT is indicated when
massive thrombus leading to impaired venous drainage, severe edema and acute limb ischemia
purpose of IVC filter
prevent death from PE
only for those who have contraindication to AC who have acute PE or acute proximal (above the knee) DVT
does distal DVT need AC?
isolated distal DVT can be monitored with serial doppler ultrasound that is done 5 to 7 days after initial event in otherwise healthy people
if no progression no AC
if you have superficial vein thrombosis treatment is primaryily
supportive care , analgesia, warm compresses and NSAIDS
get imaging if there is progressive symptoms or swelling occurs
cannulated veins of hands and arms often thrombose after infusions or IV catheter placement and this
does not need AC
if there is a superficial vein thrombosis of the great saphrenous vein this may need
a U/S to evaluate if it’s close enough to deep vein system and need AC
if lower extremity SVT <5 cm in length OR <5 cm to deep vein system, needs AC (fondaparinux is ok)
also need AC if pt has cancer or prior DVT
people who have a superficial venous thrombosis should get
follow up in 1 week to look for any advancement in symptoms
get imaging if any changes
