Pulmonary embolus

Question 1

Causes of PE

Answer 1

DVT

Right ventrical post MI/ septic emboli - rare

Question 2

Risk factors for PE: SPASMODICAL

Answer 2

Sex:F
Pregnancy
Age:↑
Surgery (classically 10d post-op straining at stool)
Malignancy
Oestrogen: OCP/HRT
DVT/PE previous Hx
Immobility
Colossal size
Antiphospholipid Abs
Lupus Anti-coagulant

Question 3

Symptoms of PE

Answer 3

Dyspnoea
Pleuritic pain
Haemoptysis
Syncope

Question 4

Signs of PE

Answer 4

Fever
Cyanosis
Tachycardia, tachypnoea
RHF: hypotension, ↑JVP 
Evidence of cause: DVT

Question 5

Investigations for PE

Answer 5

Bloods: FBC, U+E, clotting, D-dimers
ABG: normal or ↓PaO2 and ↓PaCO2, ↑pH
CXR: normal or oligaemia, linear atelectasis
ECG: sinus tachycardia, RBBB, right ventricular strain
(inverted T in V1-V4)
S1, Q3, T3 is rare
Doppler US: thigh and pelvis (+ve in 60%)
CTPA + venous phase of legs and pelvis 85-95% sensitivity

Question 6

Scoring system for PE likelihood/treatment

Answer 6

Wells’ Score

Question 7

Management of PE

Answer 7

O2
Analgaesia
If critically ill give thrombolysis - alteplase
LMWH - enoxiparin
BP: <90 give colloid and inotropes if still low, >90 warfarin

Question 8

Wells score components

Answer 8

Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins) 3pts

An alternative diagnosis is less likely than PE 3

Heart rate > 100 beats per minute 1.5

Immobilisation for more than 3 days or surgery in the previous 4 weeks 1.5

Previous DVT/PE 1.5

Haemoptysis 1

Malignancy (on treatment, treated in the last 6 months, or palliative) 1

Question 9

Wells score interpretation

Answer 9

PE likely - more than 4 points, CTPA

PE unlikely - 4 points or less, D-dimer