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Year 3: respiratory conditions > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

1
Q

define pulmonary embolism:

A

occlusion of pulmonary vessels, most commonly by a thrombus that has traveled to the pulmonary vascular system from another site.

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2
Q

what are the main causes of pulmonary embolism?

A

they are caused by thrombi

  • 95% arise from DVT in the lower limbs
  • in AF patients can arise in the right atrium.
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3
Q

what are other causes of embolus?

A 
Amniotic fluid
Air
Fat
Tumour
Mycotic(infection of the arterial wall)
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4
Q

what are the risk factors for a pulmonary embolism?

A 
Surgical patients
Immobility
Obesity
OCP
Heart failure
Malignancy
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5
Q

what is the epidemiology of a pulmonary embolism?

A
  • it is relatively common

- occurs in 10-20% of patients with a proximal DVT

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6
Q

what are the types of pulmonary embolism?

A

small
moderate
large

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7
Q

how might a small PE present?

A

might be asymptomatic

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8
Q

how might a moderate PE present?

A
  • sudden onset SOB
  • cough
  • hemoptysis
  • pleuritic chest pain
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9
Q

how might a large PE present?

A
  • severe central pleuritic chest pain
  • shock
  • collapse
  • acute right heart failure
  • sudden death
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10
Q

when might one get multiple small recurrent PEs?

A
  • pulmonary hypertension
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11
Q

what scorings can be used for PEs?

A
  • PERC score to predict a PE

- Wells criteria to decide investigations for a PE

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12
Q

How to use the Wells score for PE?

A
  • low probability 4 or less =
    d-dimer
  • high probability higher than 4 = use imaging = CTPA
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13
Q

what other investigations should be carried out for a PE?

A
  • Bloods - ABG and thrombophilia screen
  • ECG
  • CXR
  • VQ scan
  • pulmonary angiography
  • doppler US of lower limb
  • echocardiogram
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14
Q

what might an ECG show after a PE?

A
  • May be normal
  • May show tachycardia, right axis deviation or RBBB
  • May show S1Q3T3 pattern
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15
Q

what might CXR show after a PE?

A
  • often normal but might exclude other diagnoses
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16
Q

what might a CTPA show after a PE?

A
  • poor sensitivity for small emboli

- high sensitivity for medium to large embolisms

17
Q

what might a VQ scan show?

A
  • Identifies areas of ventilation and perfusion mismatch

- this might show an area of the infarcted lung due to the PE

18
Q

why are pulmonary angiograms not often used?

A
  • they are invasive
19
Q

why might a doppler US of the lower limb be used?

A
  • allows assessment of venous thromboembolism
20
Q

what might an echocardiogram show?

A
  • right heart strain
21
Q

How might a small PE show on physical examination?

A
  • no signs

- may be tachycardia and tachypnoea

22
Q

How might a moderate PE show on examination?

A
  • Tachypnoea
  • Tachycardia
  • Pleural rub
  • Low O2 saturation (especially after walking)
23
Q

How might a severe PE show on examination?

A
  • Shock
  • Cyanosis
  • Signs of right heart strain
24
Q

what are signs of right heart strain?

A
  • signs of pulmonary hypertension

- signs of right heart failure

25
Q

what is the primary prevention for pulmonary embolism?

A
  • compression stockings
  • Heparin prophylaxis
  • Good mobilization and adequate hydration
26
Q

what is primary management for a hemodynamically stable PE patient?

A
  • provide O2
  • anticoagulation with heparin or LMWH
  • then switch to warfarin for at least 3 months
  • provide analgesia
27
Q

what is primary management for a hemodynamically unstable PE patient?

A
  • Resuscitate
  • O2
  • IV fluids
  • thrombolysis if cardiac arrest is imminant
28
Q

complications of a PE?

A
  • Death
  • Pulmonary infarction
  • Pulmonary hypertension
  • Right heart failure
29
Q

the prognosis for pulmonary embolism?

A
  • 30% mortality untreated
  • 8% of mortality treated
  • the increased future risk of thromboembolic disease

Year 3: respiratory conditions (16 decks)

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