Pulmonary Embolism Flashcards
1
Q
When will you suspect PE?
A
- sudden collapse 1-2 weeks after surgery
2
Q
What is the Px of PE?
A
- DVT develops in veins
- Embolise through veneous system into the right side of heart
- Travel to pulmonary arteries
- Block blood flow to lung tissue
- Create strain on right heart
3
Q
Which veins do DVT commonly occur?
A
- External iliac
- Femoral
- Popliteal
- Posterior tibial
4
Q
What are the 5 fates of a thrombus?
A
- resolution
- propagation
- embolisation
- organisation
- recanulisation
5
Q
What are the RF for PE?
A
- Immobility
- Recent surgery
- Long haul flights
- Pregnancy
- Hormone therapy with oestrogen
- Malignancy
- Polycythaemia
- SLE
- Thrombophilia
6
Q
What are the sx of PE?
A
- dyspnoea
- pleuritic chest pain - worse on inspiration
- haemoptysis
7
Q
What are the clinical signs of PE?
A
- Hypotension
- Reduced air entry
- tachycardic
- Tachypnea
- loud P2
- cyanosis
- pleural rub
- DVT signs
- leg swelling
8
Q
A
9
Q
What scoring system will you use for PE?
A
- Well’s criteria
- Likely > perform CTPA
- Unlikely > perform d-dimers. If + then CTPA
10
Q
What is the definitive Ix of PE?
A
- CTPA
- V/Q scan
11
Q
What other Ix would you order for PE?
A
- Bedside
- ECG
- Bloods
- FBC, U&E, clotting test, d-dimers
- ABG
- Imaging
- CXR
12
Q
What ECG features would PE show?
A
- Normal (majority of times)
- Sinus tachycardic
- R Ventricular strain
- inverted T wave (v1-v4)
- S1Q3T3
13
Q
What are the CXR features of PE?
A
- Normal (majority of times)
- small pleura effusion
- enlarged pulmonary artery
- atelactasis
14
Q
How would you initially mx PE?
A
- Oxygen - 10-15L/min
- Morphine 5-10mg + antiemetic
- Bolus fluid
- First line:
- Apixaban or rivaroxaban
- If not suitable
- LMWH
- If massive PE/hemodynamically unstable
- Thrombolytics
- streptokinase, alteplase
- Thrombolytics
15
Q
How would you mx PE long term?
A
- Warfarin
- DOAC
