Pulmonary embolus

Question 1

What are the Wells criteria for PE?

Answer 1

signs of DVT (leg swelling and pain)- 3 points
alternative diagnosis less likely- 3 points
HR >100 bpm- 1.5 points
immobilisation> 3days/ surgery last 4 weeks- 1.5 points
previous PE/ DVT- 1.5 points
haemoptysis- 1 point
malignancy (or treated in last 6 months)- 1 point
< or equal to 4 PE unlikely, >4 probable PE

Question 2

What is the typical presentation of PE?

Answer 2

Retrosternal chest pain +/- syncope, breathlessness

Hypotension, acute right heart failure, cardiac arrest with massive PE

Question 3

What investigations help in the diagnosis of PE?

Answer 3

V/Q scan, CTPa, CXR, ECG, Doppler of lower limbs

Question 4

What is the typical presentation of PE?

Answer 4

Retrosternal chest pain +/- syncope, breathlessness

Hypotension, acute right heart failure, cardiac arrest with massive PE

Question 5

What investigations help in the diagnosis of PE?

Answer 5

V/Q scan, CTPa, CXR, ECG, Doppler of lower limbs

Question 6

What are some risk factors for DVT?

Answer 6

Family history, thrombophilia, history of previous thromboembolism, drugs (OCP, tamoxifen, HRT), malignancy, age >40, varicose veins, significant illness, recent surgery, immobility, long flights, pregnancy, obesity, dehydration

Question 7

What are signs/ symptoms of DVT?

Answer 7

Swelling of calf/ thigh
Asymmetry
Erythema
Superficial veins
Warmth
Tenderness
Pitting oedema

Question 8

What investigation should be performed for suspected DVT?

Answer 8

Duplex ultrasound- should be repeated in 1 week if initial test normal but still suspicious.

Question 9

What are some preventative measures for DVT?

Answer 9

Post surgery: early ambulation, clexane, TEDs, physiotherapy, pneumatic compression, electric calf muscle stimulation during surgery, exercises during long flights