Pulmonary Embolus Flashcards
What is a pulmonary embolus (PE)?
- blockage of one or more pulmonary a. (large or small)
Where do 5% of PE’s occur?
- bifurcation of the pulmonary a.
What is the MC source of PE?
- pelvic/deep thigh v. clot
What are the other uncommon causes of PE?
- air
- amniotic fluid
- fat
- FB/septic
- parasite eggs
- tummor
How do 50% of PE patients present?
- asymptomatically
What is the pathophysiology of PE?
- clot obstructs pulm a. which increases pulm vascular resistance
- vasoactive substances released which further increase pulm vascular resistance
- increased pulm vascular resistance leads to V/Q mismatch
- V/Q mismatch impairs gas exchange
signs and symptoms of PE
- dyspnea (shortness of breath, SOB)
- pleuritic chest pain-
- hemoptysis
- cough
- LE pain/swelling
- sense of impending doom
- syncope
- palpitations
What are the risk factors for PE?
- Virchow triad (venous stasis, vessel wall injury, hypercoagulability)
What are the general findings on PE exam?
- dyspnea or pleuritic pain
- anxious
- cyanosis
What are the vital finding on PE exam?
- tachypnea
- tachycardia
- hypotension
What are the ascultative findings on PE exam?
- nothing vs. wheezing/rales
- tachycardia
What are the findings on the extremities on PE exam?
- pain
- swelling
- Homan’s sign
How is a diagnosis of PE made?
- PERC
- Wells Criteria
What are the CXR findings on PE exam?
- Fleischner sign
- Westermark sign
- Hampton hump
What is Fleischner sign?
- seen on CXR
- distended central pulmonary artery d/t presence of a large clot
What is Westermark sign?
- seen on CXR
- oligemia (less vascular) distal to the embolism
What is a Hampton hump?
- seen on CXR
- pleural-based wedge shaped consolidation found anywhere in the lung
What is the work-up for PE?
- *D-dimer
- CT Angiography (CTA)
- V/Q Scan
- ECHO (US)
- labs as dictated by DDX
What is the treatment for PE?
- anticoagulation
- thyrombolytics/thrombectomy
- IVC filter
What is the anticoagulation therapy for PE?
- coumadin/warfrin + LMWH x 5d or until INR b/t 2-3
- factor Xa inhibitors (newer agent - preferred)
How long does anticoag therapy for PE last?
- 3-6mo
What is the anticoag treatment for moderate to severe cases of PE?
- heparin
What are the strongest predictors of PE?
- (+) hx DVT/PE
- metastatic disease
What are risk factors of PE?
- chemo & radiation
- central venous access device
- Hb < 10 & WBC > 11 = 2x risk
- platless > 350
What patient population is 4x more likely to have a DVT or PE?
- 3rd trimester pregers
- post-partum
Why is it that the patient pop who is 4x more likely to have DVT or PE gets one?
- hypercoagulable state
- additional risk : preeclampsia, c-section, anemia, hemorrhage, post partum infection, & IVF
- compression of iliac v. from gravida uterus
When is a D-dimer useful in the dx of PE?
- only when negative
What do you do with a positive LE US in the patient population that is 4x more likely to have a DVT/PE?
- treat
______ (test) is preferred over ______ (test) in the patient population that is 4x more likely to have a DVT/PE because it is ______ sensitive with _____ radiation.
- CTA
- V/Q Scan
- more
- less
What is the plan for a PE diagnosis?
- uncomplicated cases can go home
- pregers or CA admitted
Who are at risk for PE?
- cancer patients
What is the most common CC of PE?
- dyspnea
What does an EKG read for a PE?
- S1Q3T3
pulmonary embolism (DDX)
- MI
- PNA
- effusion
- pericarditis
- PTX
- costochondritis
