Pulmonary Embolism PE

Question 1

DVT

Answer 1

Formation of a blood clot (thrombus) within a deep vein mainly found in the leg

Question 2

DVT presentation

Answer 2

Red, hot, swollen, tender, painful leg

Can be assymptomatic

Question 3

DVT investigations

Answer 3

Ultrasound - first line, non invasive
D-dimer test
CT scan

Question 4

PE

Answer 4

When a blood vessel in the lungs becomes blocked (mainly by a blood clot).

Question 5

Clinical presentation

Answer 5

Large: hypotension, CV shock, sudden death, collapse

Medium: pleuritic chest pain, acute breathlessness, haemoptysis

Small: progressive breathlessness, RHF, pulmonary hypertension

Question 6

Clinical signs

Answer 6

Tachycardia
Tachypnoea
Cyanosis
Fever
Crackles
Pleural rub 
Pleural effusion

Question 7

Investigations

Answer 7

ABG: respiratory alkalosis

CXR: consolidation

D-dimers: raised suggestion blood clot in bloodstream

V/Q scan: good V, bad Q. If this test is abnormal then it’s highly likely to be a PE

CTPA: Gold standard. Image of pulmonary artery filling defect, picks up larger clots

US: detects silent DVT, no radiation

Echo: measure pulmonary artery pressure an RV size

Question 8

Management

Answer 8

Surgery: for serious PE

Anticoagulation: stops blood clotting and stops present clots from getting larger.

• LMWH: IV injection, first line, take for 5 days THEN
• Warfarin: Oral, 3-6 months use OR
• Dabigatran: oral thrombin inhibitor, don’t need to monitor OR
• Rivaroxaban: oral factor X inhibitor, don’t need to monitor

Thrombolysis: for massive PE, tPA

Question 9

Risk factors for DVT & PE

Answer 9

Immobility
Post-op
Long haul flights
Contraceptive pill
Pregnancy 
Trauma
Malignancy
Obesity

Question 10

Prevention of DVT & PE

Answer 10

Compression stockings post-op

Early post-op mobilisation