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Gen Med Unit 6 > Pulmonary Embolus > Flashcards

Pulmonary Embolus Flashcards

1
Q

Define pulmonary embolus

A
  1. Obstruction of pulmonary arterial bed by a dislodged thrombus or heart valve vegetation
  2. Serious and potentially fatal condition
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2
Q

Where do PE’s usually arise from?

A
  1. Arise from:
    A. Thrombus in venous circulation
    B. Thrombus from right side of heart
  2. > 90% originate from clots in deep veins of lower extremities
  3. Approx. 50-70% of symptomatic PE’s have LE DVT when diagnosed
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3
Q

Where else can PEs arise from?

A
  1. Air embolus from central lines
  2. Amniotic fluid from active labor
  3. Fat embolus from femur fracture
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4
Q

what is Virchow’s Triad? What are its components?

A

3 categories of factors that are thought to contribute to thrombosis:
A. Hypercoagulability
B. Hemodynamic changes (stasis, turbulence)
C. Endothelial injury/dysfunction

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5
Q

What risk factors are asst. with pulmonary embolism?

A 
1. Surgical procedure
A. Ortho, pelvic, abdominal
2. Cancer
3. Oral contraceptives
4. Pregnancy
5. Bedrest (prolonged nonactivity)
6. Prior Hx DVT or PE
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6
Q

What causes a thrombus to dislodge?

A
  1. Trauma
  2. Intravascular pressure changes
  3. Change in peripheral blood flow
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7
Q

What is the pathophys of PE?

A
  1. Starts with (Virchow’s Triad):
    Vascular wall damage
    or Venostasis or Hypercoaguability
  2. Thrombus dislodges
  3. Embolus →right side of heart → pulmonary artery
  4. Embolus occludes pulmonary arterial vessel
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8
Q

What happens when an embolus occludes the pulmonary arterial vessel?

A
  1. Prevents alveoli from producing sufficient surfactant
  2. Alveoli collapse
  3. Atelectasis develops
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9
Q

What are the symptoms of PE?

A
  1. Nonspecific
  2. Pleuritic chest pain
  3. Dyspnea
  4. Apprehension
  5. Cough
  6. Hemoptysis
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10
Q

What are the signs of PE?

A
  1. Tachycardia
  2. Tachypnea
  3. Rales
  4. Low grade fever
  5. ↓ PaO2
  6. Loud S2
  7. +/- LE edema
  8. S3 or S4 gallop
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11
Q

What are the ABG results in PE?

A

Resp alkalosis secondary to hyperventilation

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12
Q

What are the EKG results in PE?

A
  1. Sinus tachycardia
  2. Non specific ST-T wave abnormalities
  3. S1Q3T3
    A. Seen in < 20% patients
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13
Q

What is the D-dimer test?

A

degradation product of fibrin

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14
Q

What are the D-dimer results in PE?

A
  1. ↑ in presence of thrombus
  2. Sensitivity 95-97%, specificity 45%
  3. Can be used as a screen to R/O thrombosis
  4. > 250 ng/mL D-Dimer Units (DDU)
  5. > 0.5 mcg/mL Fibrinogen Equivalent Units (FEU)
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15
Q

What are the CXR results in PE?

A 
1. May be normal (most commonly) or show non-specific abnormalities
A. Atelectasis
B. Prominent PA
C. Elevated hemidiaphragm
D. May show Hampton's hump
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16
Q

What is a ventilation/perfusion scan and when is it indicated?

A
  1. Demonstrates perfusion defect with normal ventilation

2. Done if contraindication to CT contrast dye or CT not available

17
Q

What is the initial test for identifying a PE?

A

Spiral CT, noninvasive

18
Q

What is the definitive test for PE?

A
  1. Pulmonary CT angiogram

A. Rarely used unless non-invasive testing leaves uncertainty of diagnosis

19
Q

What are the treatment goals in PE?

A
  1. Maintain adequate cardiovascular & pulm function during resolution of obstruction
  2. Prevent recurrence of emboli
20
Q

What are the anticoagulation treatment options for PE?

A

Recurrent PE requires life long anticoagulation

  1. LMW heparin
    A. Enoxaparin (Lovenox) SQ q 12h x 5+ days
    B. Fondaparinux (Arixtra) SQ qd x 5+ days
    C. Rivaroxaban (Xarelto) PO bid x 21 days
    D. Dalteparin (Fragmin) SQ qd-bid x 5+ days
    AND
  2. Start warfarin (Coumadin) 2-10 mg qd
    A. Maintain INR 2.0-3.0 (goal 2.5)
21
Q

What are SpO2 goals for PE treatment?

A

Oxygen therapy to maintain SaO2 > 90%

22
Q

What is Inferior IVC Filter? When is it indicated?

A
  1. Indicated in patients who are at high risk of recurrence or when anticoagulants are a major contraindication
  2. Filters blood returning to heart & lungs
23
Q

What are the anticoagulation guidelines for PE?

A
  1. 3 mo of anticoagulation after first episode provoked by surgery or a transient nonsurgical risk factor
  2. 6-12 mo for unprovoked episode w/low to moderate risk of bleeding (3 mo if high risk of bleeding)
24
Q

How is PE prevented in high risk pts?

A
  1. For high risk patients:
    A. Early ambulation
    Intermittent pneumatic compression stockings
    B. Low molecular weight heparin or low dose heparin

Gen Med Unit 6 (14 decks)

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