pulmonary embolism -PE

Question 1

mortality in diagnosed and treated PE

Answer 1

7%

Question 2

Diff diagnosis

Answer 2

Asthma
ACS
pneumonia
anxiety

Question 3

MCC presentation of PE

Answer 3

dyspnea

Question 4

other presentations of PE

Answer 4

pleuritic chest pain

hemoptysis

Question 5

presentation of massive PE

Answer 5

syncope with cyanosis

cardiac arrest

angina

Question 6

important questions in history for PE

Answer 6

concurrent illness

surgical procedures

recent hospital admissions

past history, including DVT and PE

travel and family history

Question 7

hypotension indicates

Answer 7

massive PE

Question 8

examination findings

Answer 8

tachycardia

tachypnea

low SO2

pyrexia -infarction

sings of DVT -leg examination

Question 9

investigations

Answer 9

FBC
U&E
CXR - to look for pneumothorax or pneumonia
ECG - to look for MI or pericarditis
D dimer is well’s score is <4 or PE unlikely

Question 10

Diagnostic imaging for pulmonary embolus

Answer 10

CTPA

Planar V/Q

V/Q single-photon emission CT (SPECT)

Question 11

CTPA

Answer 11

uses a higher dose of radiation (not good for young patients) but will give a definitive answer, as well
as diagnose other conditions (like aortic dissection).

Question 12

V/Q scan

Answer 12

use a lower
dose of radiation but may not give a definitive answer.

The V/Q scan result
must concord with the clinical probability to diagnose or exclude PE (both
PE unlikely or both PE likely).

Question 13

management of PE as outpatient

Answer 13

if:
ambulant
normal SO2, HR and RR

Question 14

management of PE: hospital admission

Answer 14

if there is:
hypoxia
hypotension
tachycardia
tachypnoea
unable to cope at home

Question 15

when to start anticoagulant

Answer 15

when:

PE is confirmed

> 4 hours to diagnose in a high risk patient

Question 16

choices of anticoagulant

Answer 16

enoxaparin

rivaroxaban

apixaban

dalteparin

Unfractionated heparin

Tinzaparin

Question 17

Mgmt: massive PE

Answer 17

Bedside Echo - dilated RV

Bedside U/S - DVT

Question 18

in unstable patient with suspected PE-which investigation to be done

Answer 18

no CT or V/Q scan

start thrombolysis

Question 19

thrombolysis in suspected PE or unstable patient

Answer 19

alteplase (rtPA) 10mg slow IV over 1–2min, followed by 90mg IVI over 2hr (max dose 1.5mg/kg if patient is <65kg).

then unfractionated heparin IVI

Question 20

if thrombolysis is contraindicated

Answer 20

embolectomy

catheter-directed thrombolysis