Pulmonary Embolus Flashcards

1
Q

What is a pulmonary embolus (PE)?

A
  • blockage of one or more pulmonary a. (large or small)
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2
Q

Where do 5% of PE’s occur?

A
  • bifurcation of the pulmonary a.
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3
Q

What is the MC source of PE?

A
  • pelvic/deep thigh v. clot
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4
Q

What are the other uncommon causes of PE?

A
  • air
  • amniotic fluid
  • fat
  • FB/septic
  • parasite eggs
  • tummor
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5
Q

How do 50% of PE patients present?

A
  • asymptomatically
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6
Q

What is the pathophysiology of PE?

A
  • 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
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7
Q

signs and symptoms of PE

A
  • dyspnea (shortness of breath, SOB)
  • pleuritic chest pain-
  • hemoptysis
  • cough
  • LE pain/swelling
  • sense of impending doom
  • syncope
  • palpitations
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8
Q

What are the risk factors for PE?

A
  • Virchow triad (venous stasis, vessel wall injury, hypercoagulability)
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9
Q

What are the general findings on PE exam?

A
  • dyspnea or pleuritic pain
  • anxious
  • cyanosis
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10
Q

What are the vital finding on PE exam?

A
  • tachypnea
  • tachycardia
  • hypotension
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11
Q

What are the ascultative findings on PE exam?

A
  • nothing vs. wheezing/rales

- tachycardia

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12
Q

What are the findings on the extremities on PE exam?

A
  • pain
  • swelling
  • Homan’s sign
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13
Q

How is a diagnosis of PE made?

A
  • PERC

- Wells Criteria

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14
Q

What are the CXR findings on PE exam?

A
  • Fleischner sign
  • Westermark sign
  • Hampton hump
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15
Q

What is Fleischner sign?

A
  • seen on CXR

- distended central pulmonary artery d/t presence of a large clot

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16
Q

What is Westermark sign?

A
  • seen on CXR

- oligemia (less vascular) distal to the embolism

17
Q

What is a Hampton hump?

A
  • seen on CXR

- pleural-based wedge shaped consolidation found anywhere in the lung

18
Q

What is the work-up for PE?

A
  • *D-dimer
  • CT Angiography (CTA)
  • V/Q Scan
  • ECHO (US)
  • labs as dictated by DDX
19
Q

What is the treatment for PE?

A
  • anticoagulation
  • thyrombolytics/thrombectomy
  • IVC filter
20
Q

What is the anticoagulation therapy for PE?

A
  • coumadin/warfrin + LMWH x 5d or until INR b/t 2-3

- factor Xa inhibitors (newer agent - preferred)

21
Q

How long does anticoag therapy for PE last?

A
  • 3-6mo
22
Q

What is the anticoag treatment for moderate to severe cases of PE?

A
  • heparin
23
Q

What are the strongest predictors of PE?

A
  • (+) hx DVT/PE

- metastatic disease

24
Q

What are risk factors of PE?

A
  • chemo & radiation
  • central venous access device
  • Hb < 10 & WBC > 11 = 2x risk
  • platless > 350
25
Q

What patient population is 4x more likely to have a DVT or PE?

A
  • 3rd trimester pregers

- post-partum

26
Q

Why is it that the patient pop who is 4x more likely to have DVT or PE gets one?

A
  • hypercoagulable state
  • additional risk : preeclampsia, c-section, anemia, hemorrhage, post partum infection, & IVF
  • compression of iliac v. from gravida uterus
27
Q

When is a D-dimer useful in the dx of PE?

A
  • only when negative
28
Q

What do you do with a positive LE US in the patient population that is 4x more likely to have a DVT/PE?

A
  • treat
29
Q

______ (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.

A
  • CTA
  • V/Q Scan
  • more
  • less
30
Q

What is the plan for a PE diagnosis?

A
  • uncomplicated cases can go home

- pregers or CA admitted

31
Q

Who are at risk for PE?

A
  • cancer patients
32
Q

What is the most common CC of PE?

A
  • dyspnea
33
Q

What does an EKG read for a PE?

A
  • S1Q3T3
34
Q

pulmonary embolism (DDX)

A
  • MI
  • PNA
  • effusion
  • pericarditis
  • PTX
  • costochondritis