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Y1 - Respiratory > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

1
Q

What is a pulmonary embolism?

A

The blockage of a pulmonary artery by a blood clot, fat, tumour or air

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2
Q

What condition does a pulmonary embolism often follow, and where is this condition found?

A

DVT - ileo-femoral vein

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3
Q

What factors make up Virchow’s triad?

A

Venous stasis
Vessel wall damage
Hyper-coagulability

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4
Q

What can cause venous stasis?

A 
Increasing age
Obesity
Immobility
Varicose veins
Pregnancy
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5
Q

What can cause vessel wall damage?

A

Trauma
Previous DVT
Surgery

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6
Q

What can cause hyper-coagulability?

A 
Pregnancy
Cancer
High oestrogen state
IBD
Blood transfusion
Anti-thrombin, protein C or protein S deficiency
Thrombophilia
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7
Q

What are some key words in a history of pulmonary embolism?

A 
Collapses
Breathlessness
Pleuritic chest pain
Tachycardia
Tachypnoea
Obesity
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8
Q

What are the symptoms of pulmonary embolism?

A 
Acute onset:
Pleuritic chest pain, usually unilateral
Dyspnoea
Sense of apprehension
Haemoptysis
Collapse
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9
Q

What are signs of pulmonary embolism?

A 
Hypoxaemia
Tachycardia
Hypotension
Cyanosis
Crepitation on auscultation
Pleural rub
Elevated JVP
Fever
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10
Q

What are features of a small recurrent pulmonary embolism?

A

Progressive dyspnoea
Pulmonary hypertension
Right heart failure

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11
Q

What are signs of DVT?

A

Unilateral leg pain and swelling
Change to skin colour and temperature
Venous distension

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12
Q

What diagnostic criteria is used for pulmonary embolism?

A

Well’s score

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13
Q

What diagnostic score is likely and unlikely to be a pulmonary embolism?

A

<4 - unlikely

>4 - likely

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14
Q

What is the diagnostic investigation for pulmonary embolism?

A

CT pulmonary angiogram

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15
Q

When are D-dimers done in pulmonary embolism investigation?

A

If Well’s score says PE is unlikely but there is clinical suspicion

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16
Q

What does a positive and negative D-dimer result mean?

A

Positive (raised levels) - PE very likely so start treatment and then confirm with CTPA
Negative (levels normal) - PE negative, look for other cause

17
Q

What are signs of haemodynamic instability?

A

Cardiac arrest
Obstructive shock
Persistent hypotension

18
Q

What are signs of obstructive shock

A 
SBP<90
End organ hypoperfusion causing: 
- Altered mental state
- Cold and clammy
- Oliguria
- Increased serum lactate
19
Q

What result on ECG is suggestive of pulmonary embolism?

A

RV overload

Or sinus tachycardia

20
Q

Why is a CT pulmonary angiogram used?

A

Visualises pulmonary artery obstruction

21
Q

When is CT pulmonary angiogram contraindicated?

A

Pregnancy
Contrast allergy
Renal impairment

22
Q

What investigation is done for diagnosis if CT pulmonary angiogram contraindicated?

A

V/Q scan (ventilation/perfusion scan)

23
Q

What are some conditions that present similarly to pulmonary embolism?

A 
Unstable angina
MI
Congestive heart failure
Pneumonia
Acute bronchitis
Exacerbation of COPD or asthma
Pericarditis
Cardiac tamponade
Pneumothorax
24
Q

What is the immediate management for pulmonary embolism?

A

Anticoagulation:
LMWH e.g. dalteparin
Warfarin

25
Q

What is the management for pulmonary embolism if the patient is haemodynamically unstable (high risk)?

A 
Oxygen
Anaglesia
IV fluids
Primary reperfusion
Systemic thrombolysis
Vasoactive drugs
Anti-coagulation
26
Q

What is the management for pulmonary embolism if the patient is moderate risk?

A

Anticoagulation
Monitor closely
Rescue reperfusion if any signs of haemodynamic instability

27
Q

What is the management for pulmonary embolism if the patient is low risk?

A

Anticoagulation

28
Q

What are the contraindications for anticoagulation?

A

Active bleeding
Recent intracranial haemorrhage
Aortic dissection
Low platelets

29
Q

What is the treatment for massive pulmonary embolism?

A

Thrombolysis with tPA (alteplase) or streptokinase

30
Q

What can happen if pulmonary embolism is not treated, and how?

A

Right heart failure and cardiac arrest
PE increases pulmonary vasculature resistance
This increases work done by RV
This is compensated by increasing heart rate, until this mechanism is overwhelmed and RV over-distends
RV end-diastolic pressure increased and cardiac output decreased, causing decreased LV preload
MAP decreases and causes hypotension and shock

Y1 - Respiratory (12 decks)

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