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#Phase 2.2: Acute Care > Pulmonary Embolism (PE) > Flashcards

Pulmonary Embolism (PE) Flashcards

1
Q

What is PE?

A

Condition when 1+ emboli (arising from thrombus formed in veins) obst Pulmonary Arteries –> Resp dysfunction

(usually from DVT in legs)

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2
Q

What is the passage of the thrombus before it reaches pulmonary circulation? (3 things)

A
  1. Veins (breaks off from here)
  2. Right side of heart
  3. Pulmonary Circulation
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3
Q

What are the Risk Factors for a PE? (10 things)

A
  1. Age
  2. Pregnancy
  3. COCP / Hormone Therapy
  4. Obesity
  5. Immobility (Long flights / casts)
  6. Surgery (esp pelvic / orthopaedic)
  7. Trauma
  8. DVT Hx
  9. Cancer
  10. Thrombophilia (e.g antiphospholipid syndrome)
  11. Leg / Hip # (FAT EMBOLISM)

same as DVT RFs

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4
Q

What is the pathophysiology of the LUNG clartation that happens in PE? (4 steps)

A

V/Q (ventilation / perfusion) mismatch

  1. Ventilation WITHOUT Perfusion (Alveolar DEAD SPACE)
  2. Inflamm mediators released
  3. Vasoconstriction
  4. Decreased blood flow to Alveoli

(Alveoli considered DEAD SPACE bc still ventilated but not perfused)

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5
Q

What is the pathophysiology of the RIGHT HEART clartation (aka Haemodynamic Instability) that happens in PE? (7 steps)

A
  1. PE occur in Pulmonary Arteries from R Heart to Lungs
  2. PE –> Increased Pulmonary Vascular Resistance (PVR)
  3. Decreased ejection from Right Ventricle
  4. Increased Central Venous Pressure (CVP)*
  5. RV strain + distension
  6. RV decreased contractility
  7. RHF

*(bc blood coming bk from body into R heart can’t push against da resistance)

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6
Q

What is the pathophysiology of the LEFT HEART clartation (aka Haemodynamic Instability) that happens in PE? (5 steps)

A

RHF –> LHF

  1. Decreased ejection from Right Ventricle
  2. Less blood going to lungs –> less blood returning to L Heart
  3. Decreased Left Ventricular End-Diastolic Volume (LVEDV)
  4. Decreased CO
  5. Hypotension + Tachycardia
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7
Q

What are the CF of PE? (8 things)

A
  1. Asymptomatic (if small emboli)
  2. Low grade Fever
  3. SOB / Tachypnoea
  4. Cough (+/- haemoptysis)
  5. Pleuritic Chest pain
  6. Crackles
  7. Haemodynamic instability –> Hypotension + Tachycardia
  8. DVT signs (unilateral leg swelling + tenderness)
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8
Q

What are the ECG changes seen in a PE? (3 things)

A
  1. Sinus tachycardia (44%) (bc haem instab)
  2. T Wave inversion (in V1-4) (34%) (bc RV strain)
  3. RBBB (18%)
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9
Q

What investigations should you do for sus PE? (4 things)

A
  1. Well’s Score for PE (bit different to DVT one)
  2. CT Pulmonary Angiogram (CTPA)
  3. V/Q Scan
  4. D-Dimer

Bold ones = definitive diagnosis

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10
Q

What does the Well’s Score for PE tell you in sus PE?

A

The likeliness of a PE

4+ score = DVT likely

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11
Q

What does the Well’s Score for PE include? (5 things)

A
  1. Clinical signs of DVT (3 points)
  2. Recent surgery (1.5 points)
  3. Tachycardia (1.5 points)
  4. Haemoptysis (1 point)
  5. Cancer (1 point)

Ders more but jus remember dese 5

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12
Q

What should you do if the Well’s Score is 4+, aka PE = likely?

A

CT Pulmonary Angiogram (CTPA)

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13
Q

Who should you NOT do CTPAs on? (3 things)

What scan should you do instead if there Well’s Score is 4+, aka PE is likely?

A
  1. Renal Impairment
  2. Contrast allergy
  3. Risk from radiation

Do V/Q Scan on dem instead

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14
Q

What should you do if the Well’s Score is 3-, aka PE = unlikely?

A

D-Dimer

And if positive, do a CTPA (or V/Q Scan)

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15
Q

What is a CT Pulmonary Angiogram?

A

CT of chest w IV contrast

Lets u see any clots in pulmonary arteries

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16
Q

What are the FIRST LINE management options for PE?

A

DOACs (Apixaban / Rivaroxaban)

same as DVT

17
Q

What are the SECOND LINE management options for PE? (2 things)

A

LMWH (Low Molecular Weight Heparin)

with

Dabigatran / Edoxaban (DOACs) OR Warfarin (Vit K antagonist)

same as DVT

18
Q

What is the FIRST LINE treatment for PE but has severe Renal impairment / Antiphospholipid syndrome?

A

LMWH / Unfractionated Heparin

(DOACs not safe in Renal Impairment bc meant to be cleared by Kidney)

same as DVT

19
Q

What is the FIRST LINE treatment of PE in Pregnancy / Breastfeeding?

A

LMWH

DOACs not safe in pregnancy / breastfeeding

same as DVT

20
Q

How long should PE patients take their Anticoagulation meds for?

A

At least 3 months

21
Q

After 3 months of anticoagulation meds, what determines if a PE pt should carry on / stops meds?

A

If DVT–>PE was provoked by an acc event (e.g immobilisation after surgery) (can stop)

or if they jus have acc risk factors (carry on taking for 3 more months)

22
Q

After 6 month course of anticoagulation meds (bc DVT–>PE was unprovoked), what should you do for a PE pt who will now stop taking meds? (2 things)

A

Test them for:

  1. Antiphospholipid syndrome (check for antibodies)
  2. Hereditary thrombophilias (only if have 1st Degree FHx of DVT / PE)
23
Q

What is the management option for a MASSIVE PE causing Haemodynamic Instability?

A

Thrombolysis

24
Q

What is Thrombolysis?

A

Injecting Fibrinolytic meds to break down massive PE clots

25
Q

What is an example of a Fibrinolytic med?

A

Streptokinase

26
Q

How is Thrombolysis performed? (2 ways)

A
  1. IV using Peripheral Cannula
  2. Catheter Directed Thrombolysis: directly into Pulm arteries using Central Catheter

#Phase 2.2: Acute Care (31 decks)

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