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NCM118 > Pulmonary Embolism Part 1 > Flashcards

Pulmonary Embolism Part 1 Flashcards

1
Q

— refers to the obstruction of the —– or one of its branches by a —- (or thrombi) that originate(s) somewhere in the — or in the —.

A

Pulmonary embolism (PE), pulmonary artery, thrombus, venous system, right side of the heart

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2
Q

Most commonly, PE is due to a

A

dislodged or fragmented DVT

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3
Q

other types of emboli that may be implicated:

A

air, fat, amniotic fluid, and septic

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4
Q

PE is describe as an —- of the outflow tract of the main pulmonary artery or of the — of the pulmonary arteries

A

occlusion
bifurcation

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5
Q

Multiple small emboli can lodge in the terminal pulmonary arterioles, producing

A

multiple small infarctions of the lungs

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6
Q

pulmonary infarction causes — of part of the lung

A

Ischemic necrosis

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7
Q

When a thrombus completely or partially obstructs a pulmonary artery or its branches, the

A

alveolar dead space is increased

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8
Q

a reaction that compounds the ventilation–perfusion (V./Q.) imbalance that ensues.

A

increase in pulmonary vascular resistance

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9
Q

hemodynamic consequences

A

increased pulmonary vascular
resistance

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10
Q

The hemodynamic consequences are increased pulmonary vascular resistance due to the

A

regional vasoconstriction and reduced size of the pulmonary vascular bed.

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11
Q

When the work requirements of the right ventricle exceed its capacity, right ventricular failure occurs, leading to a

A

decrease in cardiac output
decrease in systemic blood pressure
development of shock

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12
Q

Clinical manifestations

A

depend on the size of the thrombus and the area of the pulmonary artery occluded by the thrombus.
*Nonspecific
*Dyspnea
*Chest pain
*anxiety
*fever
*tachycardia
*apprehension
*cough
*diaphoresis
*hemoptysis
*syncope
*Tachypnea

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13
Q

Obstruction of the pulmonary artery can result

A

pronounced dyspnea
sudden substernal pain
rapid and weak pulse
shock
syncope
sudden death

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14
Q

is the most frequent symptom; the duration and intensity of the — depend on the extent of embolization.

A

Dyspnea

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15
Q

is common and is usually sudden and pleuritic in origin; however, it may be substernal and may mimic angina

A

Chest pain

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16
Q

The most frequent sign is

A

Tachypnea

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17
Q

In many instances, PE causes few signs and symptoms, whereas in other instances, it mimics various other

A

cardiopulmonary disorders

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18
Q

Assessment and Diagnostic Findings

A

Initial:
*Chest x-ray
*ECG
*Pulse oximetry
*ABG analysis
*D-dimer assay
*MDCTA/pulmonary arteriogram/V./Q. scan

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19
Q

is usually normal but may show infiltrates, atelectasis, elevation of the diaphragm on the affected side, or a pleural effusion. It is most helpful in excluding other possible causes.

A

Chest x-ray

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20
Q

most frequent ECG abnormality is

A

Sinus tachycardia
nonspecific ST-T wave abnormalities

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21
Q

If an arterial blood gas analysis is performed, it may show

A

Hypoxemia and hypocapnia

22
Q

may be normal even in the presence of PE

A

ABG measurements

23
Q

is the criterion standard for diagnosing PE

A

MDCTA

24
Q

can be performed quickly and provides the advantage of high-quality visualization of the lung parenchyma

A

MDCTA

25
Q

is considered a reasonable alternative diagnostic method if MDCTA is not available

A

Pulmonary angiography

26
Q

allows for direct visualization under fluoroscopy of the arterial obstruction and accurate assessment of the perfusion deficit.

A

Pulmonary angiogram

27
Q

continues to be used to diagnose PE, especially in
facilities that do not use pulmonary angiography or do not have access to MDCTA

A

V./Q. scan

28
Q

is minimally invasive and requires IV administration of a contrast agent

A

V./Q. scan

29
Q

This scan evaluates different regions of the lung (—-) and allows comparisons of the percentage of V./Q. in each area

A

upper, middle, lower

30
Q

This test has a high sensitivity but is not as accurate as an MDCTA or pulmonary angiogram

A

V./Q. scan

31
Q

Medical Mgt revolves around whether the patient is diagnosed with a

A

hemodynamically unstable PE (also called a massive PE) or a stable PE.

32
Q

hemodynamically unstable PE, which comprises a life-threatening emergency, may evidence

A

hypotension
tachycardia
confusion
cardiovascular collapse

33
Q

Medical Management of Unstable Pulmonary Embolism

A

*stabilize the cardiopulmonary system
*Emergent measures
*Thrombolytic therapy with t-PA
*surgical embolectomy
*inferior vena cava (IVC) filter

34
Q

A sudden increase in pulmonary resistance increases the work of the right ventricle, which can cause

A

acute right-sided heart failure with cardiogenic shock

35
Q

are initiated to improve respiratory and cardiovascular status

A

Emergent measures

36
Q

After emergency measures have been initiated, the treatment goal is to — the existing embolus and prevent new ones from forming

A

Lyse (dissolve)

37
Q

is used in treating unstable PE, particularly in patients who are severely compromised (hypotensive & Hypoxemia)

A

Thrombolytic therapy with t-PA or other agents such as RETEPLASE

38
Q

lyses the thrombi or emboli quickly and restores hemodynamic functioning of the pulmonary circulation, thereby reducing pulmonary hypertension and improving perfusion, oxygenation, and cardiac output.

A

Thrombolytic therapy

39
Q

Contraindications to thrombolytic therapy include having

A

*had a stroke within the past 2 months
*other active intracranial processes
*active bleeding
*surgery within 10 days of the thrombotic event
*recent labor and delivery
*trauma
*severe hypertension.

40
Q

Significant in thrombolytic therapy

A

Risk for bleeding

41
Q

These are obtained Before thrombolytic therapy is started

A

INR
aPTT
hematocrit
platelet

42
Q

is stopped prior to administration of a thrombolytic agent

A

Any anticoagulant

43
Q

During therapy, all but essential invasive procedures are avoided because of

A

Potential bleeding

44
Q

Is initiated After the thrombolytic infusion is completed (which varies in duration according to the agent used),

A

maintenance anticoagulation therapy

45
Q

is rarely performed but may be indicated if there are contraindications to thrombolytic therapy

A

Surgical embolectomy

46
Q

can be performed using catheters or surgically.

A

Embolectomy

47
Q

Surgical removal must be performed by a

A

cardiovascular surgical team with the patient on cardiopulmonary bypass

48
Q

May be inserted for patients who have recurrent PE despite therapeutic anticoagulation,

A

inferior vena cava (IVC) filter

49
Q

are not recommended for the initial treatment of patients with PE and should not be used in patients receiving anticoagulants

A

IVC filters

50
Q

provides a screen in the IVC, allowing blood to flow unobstructed while large emboli from the pelvis or lower extremities are blocked or fragmented before reaching the lung.

A

IVC filter

NCM118 (11 decks)

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