Pulmonary embolism Flashcards
what are features of the Wells score?
symptoms/signs of DVT other diagnosis is unlikely immobility for > 3 days and/or recent surgery previous VTE heart rate > 100 bpm haemoptysis active malignancy
at what score of the Wells score makes PE likely?
score > 4
what is the first line treatment for a PE?
DOAC i.e. rivaroxiban
if DOAC is unsuitable for treatment of a PE, then what drug can be used instead?
LMWH followed by dabigatran
or
LMWH followed by vitamin K agonist e.g. warfarin
if the patient has renal failure, does this change management of a PE?
yes
treat with LMWH, unfractionated heparin or LMWH followed by warfarin
describe the management of a PE.
DOAC e.g. rivaroxiban
alternatively LMWH followed by dabigatran / warfarin
continue for 3 months if provoked
continue for further 3 months (6 in total) if unprovoked or active cancer
how would you manage a patient who has been having recurrent PE despite anticoagulation?
inferior vena cave filtres
how would you determine if a patient could be treated as outpatient?
PE severity index
- no co-morbidities
- haemodynamically stable
- support/care at home
describe how you would investigate a patient who presented with symptoms suggestive of a PE.
if low suspicion - PE rule out criteria
if high suspicion - Well’s criteria
if Wells > 4 do CT pulmonary angio
if not available do V/Q scan
if delay in CTPA start DOAC
if Wells < 4 do D-dimer
if high do CTPA, start DOAC if delay, V/Q scan if unavailable
if low - alternative diagnosis
if renal impairement (<15ml/min) or allergy to contrast do V/Q scan instead of CTPA
what are signs of a PE on examination?
tachycardia tachypnoea hypotension (if massive PE) respiratory alkalosis pyrexia crackles on auscultation
what ECG signs might you find in a PE?
S1Q3T3
large S wave in lead I
large Q wave in lead III
inverted T wave in lead III
