Pulmonary Embolism

Question 1

What are the WELLS score risk factors?

Answer 1

• Clinical signs and symptoms of DVT
• PE number 1 diagnosis
• Tachy >100 BPM
• Immobilization at least 3 days OR surgery in previous 4 weeks
• Previous PE or EVT
• Haemoptysis
• Malignancy treated within 6 months

Question 2

What makes a PE likely?

Answer 2

A score of 4.5 or more

Question 3

What is the presentation of a PE?

Answer 3

*Pleuritic chest pain
*dyspnoea
*haemoptysis
*tachycardia
*tachypnoea
*respiratory examination
classically the chest will be clear

Question 4

What scoring system is used for assessing whether a PE is likely or not?

Answer 4

Wells Score

Question 5

What is done if a Wells score determines PE is likely? i.e. score of 4.5 or more

Answer 5

*Immediated CTPA
*If delay of more than 4hours likely give interim anticoagulants
>1st line DOAC
>2nd line LMWH

Question 6

What is done if a Wells score determines PE is unlikely? i.e. score of 4 or less

Answer 6

*D-dimer test

*if positive arrange CTPA: if delay likely give interim anticoags
>1st line DOACs
>2nd line LMWH

*if negative PE unlikely

Question 7

When is a V/Q scanning done instead of a CTPA?

Answer 7

If there is renal impairment as it doesn’t require contrast