Pulmonary Embolism + Pneumothorax Flashcards
Name some risk factors for DVT/PE
thrombophilia trauma/surgery contraceptive pill pregnancy malignancy immobility (bed rest, long haul flight) MI vasculitis
What are the clinical features of PE?
Chest pain SOB Tachypnoea Shock --> tachycardia, hypotension Fever Cyanosis Haemoptysis
Which scoring system is used to assess the likelihood of a PE?
Wells’ Score
Which investigation is gold standard for diagnosing PE?
CTPA (CT pulmonary angiogram)
When would a V/Q scan be used as first line to investigate a suspected PE?
Pregnancy (unless haemodynamically unstable, then CTPA should be used as more sensitive)
Allergy to contrast
Renal impairment (contrast)
When should a D-dimer be used?
If Wells’ score suggests PE unlikely
if positive –> CTPA
What is the treatment for patients with a confirmed DVT or PE?
LMWH or fondaparinux
Which treatment should be considered if a patient has a PE and is haemodynamically unstable?
Unfractionated heparin + thrombolysis
Which anticoagulant should be offered following a DVT/PE and for how long?
Warfarin (vit K antagonist) for 3 months then review risk
How can DVT/PE be prevented post-op?
Early mobilisation TED compression stockings Calf muscle exercises SC LMWH perioperatively --> dalteparin (fragmin) DOAC (direct oral anticoagulation)
Give two examples of DOAC and their mechanism of action
Dabigatran - direct thrombin inhibitor
Rivaroxaban/Apixaban - direct inhibitor of activated factor Xa
Who most commonly get pneumothorax?
Tall, thin men
Marfan’s
Smokers/cannabis
Underlying lung disease
What is the difference between primary and secondary pneumothorax?
Primary occurs in normal lungs
Secondary occurs in diseased lungs e.g. COPD
What are the symptoms of a pneumothorax?
Sudden onset pleuritic chest pain and SOB
What signs are seen in pneumothorax?
Hyper-resonance to percussion Reduced or absent breath sounds Tracheal deviation (if tension) Hypoxia Tachycardia Reduced chest expansion Hamman's sign: click on auscultation
