Pulmonary embolism

Question 1

what is the etiollg of pulmonary embolism ?

Answer 1

deep vein thrombosis

virchows triad -
1) venous stasis
immobilisation postoperative

2) hypercoagubility -
hereditary - factor 4
antithrombin 3 and protein c and s deficieny

acquired - 
antiphospholipid syndrome 
myeloproliferative disordres 
atrial fib 
malignancy 
oral contraceptives 
orthopaedicc surgery 

3) injury to the vessel wall

fat emboli from bone marrow
amniotic fluid embolism
air embolism

Question 2

what is the risk score assesemt in pulmonary embolism ?

Answer 2

simplified PESI SCORE

age over 80 
cancer 
heart failure 
cardiopulmonary disease 
pulse over 110 
arterial oxyhemoglobin saturation <90 percent 

all have one point

30 day mortality
0 points low risk
more than 1 - high risk

Question 3

classification of PE according to size ?

Answer 3

massve - more than 50 percent occlusion
systolic bp <90mmhg

non massive - no change in blood pressure just respiratory symptoms

submassive - normal bp , but echo signs of right ventricular dysfunction

Question 4

clinical manifestation of pulmonary embolism ?

Answer 4

massive 
systemic hypotension , shock 
dyspnea 
chest pain 
pale , sweaty 
mental status impaired 
neck vein distension 

non massive :
pleural pain
cough
hemoptyssis

Question 5

physical examination of PE ?

Answer 5

massive
tachypnea
tachycardia
signs of pulmonary hypertension - S2 and S3 gallop

non massive
pleural rub
dullness on percussion

Question 6

how do we diagnose PE ?

Answer 6

WELLS SCORING SYSTEM

suspected DVT = 3
other diagnosis more likely than PE =3
HR >100  = 1.5
immobilisation or previous surgery = 1.5
previous DVT and PE  = 1.5
hemoptyisis = 1
malignancy within 6 months = 1

score
low 0-2
moderate 3-6
high >6

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1st stage 
ECG - right axis deviation 
s1,q3,t3 pattern 
RBBB

x ray -
enlarged hilia
distal to occlusion atlectasisis and infiltration
pleural effusion

2nd stage 
echo - 
direct visualisation of thrombi 
signs of rv dysfunction - mc Connell sign 
tricuspid insuffieicny 
vena cava inferioir distention 

d - dimer

doppler sonography

3rd stage
lung scanning

CT - golden

pulmoangiography

Question 7

what is the treatmnet of PE

Answer 7

massive

bp low - dopamine and dobutamine

acute respiratory failure - oxygen

fibrinolytic - streptokinase , urokinase

alteplase , reteplasie

surgery

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non massive

heparin and antithrombin 3

low molecular weight heparin - enoxaparin

indirect 10 a inhibitors - fondaparinux

direct 10 a inhibitors - rivarixaban

oral warfarin

direct thrombin inhibitor - dabigatran

direct antigocuglants hirudin , lepirudin

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when there’s bleeding an anticoagulation cannot be taken

INFERIOIR VENA CAVA FILLTERS