Pulmonary Embolus

Question 1

What are the common examination findings?

Answer 1

Inspection - May be in pain or uncomfortable

Hands - Increased pulse and respiratory rate

Chest - Pleuritic pain or may show signs of effusion (stony dull, reduced expansion or vocal resonance)

LEGS - May have warm tender, swollen leg

Question 2

What are the investigations?

Answer 2

By the bed - History, obs, peak flow, spirometry and sputum, cardiovascular exam, WELLS SCORE

Bloods - FBC (anaemia or infection), CRP for infection, D dimer, thrombophilia screen

Other - CXR, ECG, ABG for respiratory failure

CTPA or US legs

Question 3

What are the key investigation findings?

Answer 3

May have:

ABG - T1RF

ECG - Sinus Tachy

D-dimer - positive

CXR - Wedge sign but often normal

Question 4

What is the treatment?

Answer 4

Conservative - Explain what is is going on and the risk factors

Medical - LMWH and warfarin loading regime (3 months if provoked 6 months if not)

If active cancer 6m LMWH

If unprovoked search for cause

Question 5

What are the risk factors

Answer 5

COCP

FH

Clotting disorders

Immobility

Obesity

Previous surgery

Pregnancy

Cancer