Pulmonary Embolus (PE) Flashcards
What is pulmonary embolism?
Thrombus formation in the pulmonary arteries
Usually the result of a DVT
Risk factors for PE
Immobility
Recent surgery
Long haul flights
Pregnancy
Hormone therapy with oestrogen
Malignancy
Polycythaemia
Systemic lupus erythematosus
Thrombophilia
VTE prophylaxis
LMWH e.g. enoxaparin
TED stockings
Presentation of PE
Shortness of breath
Cough with or without blood (haemoptysis)
Pleuritic chest pain
Hypoxia
Tachycardia
Raised respiratory rate
Low grade fever
Haemodynamic instability causing hypotension
What is Wells score used for?
Predicts the risk of a patient presenting with symptoms actually having a DVT or pulmonary embolism
Investigations in PE
CTPA
V/Q scan
Supportive management in PE
Admission to hospital
Oxygen as required
Analgesia if required
Adequate monitoring for any deterioration
Initial management of PE
LMWH e.g. apixaban or rivaroxaban
Long-term anticoagulation medications
Warfarin, NOAC or LMWH
Target INR for warfarin
2-3
How long is anticoagulation continued for after PE?
3 months if there is an obvious reversible cause (then review)
Beyond 3 months if the cause is unclear, there is recurrent VTE or there is an irreversible underlying cause such as thrombophilia. This is often 6 months in practice.
6 months in active cancer (then review)
When is thrombolysis indicatted?
Massive PE with haemodynamic compromise
