Pulmonary embolism Flashcards
Symptoms
Dyspnoea at rest or exertion Haemoptysis Chest pain Dry cough Orthopneoa Wheezing Calf or thigh pain and swelling
What kind of chest pain is it?
Unilateral, pleuritic
Can also be central, where palpation causes pain
What is orthopnoea?
Breathlessness when lying down, relieved by sitting up or standing
Signs
Tachypnoea Calf/thigh swelling Hypoxemia (low sats below 94%) Tachycardia Crackles Raised JVP Positive Wells score
What scoring system is used?
Wells score
Investigations
CTPA (CT Pulmonary angiography) D-dimer FBC Echo ECG U and E
What would you find on FBC and why is this relevant?
Polycythemia might increase risk of coagulation
Anaemia might increase risk of bleeding if patient is then given warfarin
What might an ECG show?
Right ventricular dysfunction
Sinus tachycardia
Lots of things
Why do you look at U and E?
Because you might need to adjust anticoagulant meds if there is renal impairment
Treatment
Oxygen support
Fluid resus
Heparin
Long term anticoag treatment
What is Virchow’s triad?
Stasis
Hypercoagulation
Vessel injury
Risk factors - Stasis
Long haul flights
Obesity
Pregnancy
Low cardiac output
Risk factors - hypercoagulation
DVT Thrombophlebitis recent surgery Oestrogen -CODP Pregnancy Sepsis MALIGNANCY
Risk factors -Vessel injury
Smoking
Thrombophlebitis
Lower limb trauma
What score is used to help with deciding investigations?
Wells score
