Pulmonary Embolism Flashcards

1
Q

Define pulmonary embolism

A

Occlusion of the pulmonary vessels often by an embolus from a deep vein thrombus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes/risk factors of PE?

A
Causes
• Thrombus (mostly DVT, also AF)
• Amniotic fluid
• Air
• Fat
• Tumour
• Mycotic
Risk Factors
• Surgery
• Immobility
• Obesity
• OCP
• Malignancy
• Previous/FH of VTE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the symptoms of PE?

A
  • Asymptomatic
  • Sudden onset SOB
  • Cough
  • Haemoptysis
  • Pleuritic chest pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the signs of PE?

A
  • Tachycardia
  • Tachypnoea
  • Pleural rub
  • Low O2 sats
  • Leg/calf swelling/tenderness
Massive PE
• Shock – hypotension
• Cyanosis
• CV collapse
• Acute right heart failure – raised
JVP, RV heave, accentuated S2
• Sudden death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What investigations are carried out for PE?

A

• Well’s score
- <4 = unlikely -> proceed to D-dimer
- >4 = likely -> proceed to imaging
• D-dimer (sensitive but non-specific)
- Normal – excludes PE if Well’s score is also <4
- Elevated – proceed to imaging
• CTPA – 1
st line, contraindicated in pregnancy, renal
insufficiency
• V/Q scan – inappropriate if there is co-existing lung
disease
• MR angiography – direct visualisation of thrombus

Other
• Bloods
- Thrombophilia screen
• ABG – hypoxia
• ECG – tachycardia, RBBB, RAD, S1 Q3 T3
• CXR
- Usually normal
- Westermark’s sign – oligaemia
(hyperlucent)
- Hampton’s hump – increased opacity
- Fleischner’s sign – prominent central pulmonary artery
- Exclude other differentials
• Echocardiogram – right ventricular strain
• Duplex USS of lower limb – look for DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the management fro PE?

A

Haemodynamically stable
• O2
• Analgesia
• Anticoagulation with IV unfractionated heparin or SC LMWH
• Oral warfarin therapy for >3months (target INR 2-3)

Haemodynamically unstable
• O2
• IV fluids
• Thrombolysis with tPA
• Anticoagulation with IV unfractionated heparin or SC LMWH
• Oral warfarin therapy for >3months (target INR 2-3)

Surgical
• Embolectomy
• IVC filter for recurrent PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the complications of PE?

A
  • Cardiac arrest ->death
  • Recurrent VTE
  • Pulmonary infarction
  • Pulmonary hypertension
  • Right heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly