pulmonary embolism -PE Flashcards
mortality in diagnosed and treated PE
7%
Diff diagnosis
Asthma
ACS
pneumonia
anxiety
MCC presentation of PE
dyspnea
other presentations of PE
pleuritic chest pain
hemoptysis
presentation of massive PE
syncope with cyanosis
cardiac arrest
angina
important questions in history for PE
concurrent illness
surgical procedures
recent hospital admissions
past history, including DVT and PE
travel and family history
hypotension indicates
massive PE
examination findings
tachycardia
tachypnea
low SO2
pyrexia -infarction
sings of DVT -leg examination
investigations
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
Diagnostic imaging for pulmonary embolus
CTPA
Planar V/Q
V/Q single-photon emission CT (SPECT)
CTPA
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).
V/Q scan
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).
management of PE as outpatient
if:
ambulant
normal SO2, HR and RR
management of PE: hospital admission
if there is:
hypoxia
hypotension
tachycardia
tachypnoea
unable to cope at home
when to start anticoagulant
when:
PE is confirmed
> 4 hours to diagnose in a high risk patient
choices of anticoagulant
enoxaparin
rivaroxaban
apixaban
dalteparin
Unfractionated heparin
Tinzaparin
Mgmt: massive PE
Bedside Echo - dilated RV
Bedside U/S - DVT
in unstable patient with suspected PE-which investigation to be done
no CT or V/Q scan
start thrombolysis
thrombolysis in suspected PE or unstable patient
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
if thrombolysis is contraindicated
embolectomy
catheter-directed thrombolysis
