Pulmonary Embolous

Question 1

Causes of PE

Answer 1

DVT

Right ventricular post MI/ septic emboli - rare

Question 2

Risk factors for PE: SPASMODICAL

Answer 2

Sex:F

Pregnancy

Age:↑

Surgery (classically 10d post-op straining at stool)

Malignancy

Oestrogen: OCP/HRTDVT/PE

previous Hx

Immobility

Colossal size

Antiphospholipid Abs

Lupus

Anti-coagulant

Question 3

Symptoms of PE

Answer 3

Dyspnoea

Pleuritic pain

Haemoptysis

Syncope

Question 4

Signs of PE

Answer 4

Fever

Cyanosis

Tachycardia, tachypnoea

RHF: hypotension, ↑JVP

Evidence of cause: DVT

Question 5

ABG for PE

Answer 5

normal

or ↓PaO2 and ↓PaCO2, ↑pH

Question 6

CXR of PE

Answer 6

normal or oligaemia,

linear atelectasis

Question 7

ECG of PE

Answer 7

sinus tachycardia,

RBBB,

right ventricular strain (inverted T in V1-V4)

S1, Q3, T3

Question 8

Scoring system for PE likelihood/treatment

Answer 8

Wells’ Score

Question 9

Management of PE

Answer 9

O2

Analgaesia

If critically ill give thrombolysis: alteplase

LMWH: enoxiparin at least 5 days or when INR above 2

Question 10

Wells score components

Answer 10

Sx of DVT 3pts

An alternative dx is less likely 3

HR> 100 1.5

Immobilisation> 3 days or surgery last 4 wks 1.5

Hx of DVT/PE 1.5

Haemoptysis 1

Malignancy 1

Question 11

Wells score interpretation

Answer 11

PE likely - more than 4 points, CTPA

PE unlikely - 4 points or less, D-dimer

Question 13

Long term mx of PE

Answer 13

NOAC or Warfarin

Provoked: 3 months

Unprovoked: 6months