Pulmonary Embolus (PE)

Question 1

What are the causes of PE?

Answer 1

• DVT in pelvis or legs
• right ventricular thrombus post MI
• septic emboli (right sided endocarditis)
• fat emboli
• amniotic fluid emboli
• neoplastic cells
• leg fracture

Question 2

What are the symptoms of PE?

Answer 2

• sudden onset SOB
• Pleuritic chest pain
• haemoptysis (if lung tissue infarcted)
• dizziness
• syncope

Question 3

What are the symptoms of a small PE?

Answer 3

If a small PE has impacted in a terminal pulmonary vessel then

• haemoptysis 3+ days later
• tachypnoeic
• localised pleural rub
• coarse crackles
• exudative pleural effusion
• fever

Question 4

What are the symptoms of a large PE?

Answer 4

• sudden collapse (due to obstruction of RV outflow)
• central chest pain
• shock (hypotension, peripherally shutdown)
• pale
• sweaty
• tachycardic., tachypnoea
• raised JVP

Question 5

What are the symptoms of multiple recurrent PEs?

Answer 5

• increased SOB over weeks/mnths
• weakness
• syncope
• angina
• raised JVP

Question 6

what are the signs of PE?

Answer 6

• tachypnoea
• tachycardia
• pyrexia
• cyanosis
• hypotension
• raised JVP
• pleural rub
• pleural effusion

Signs of DVT:
1 hot, swollen, red leg

Question 7

What invx are done for PE?

Answer 7

1) D-dimer (negative rules out PE)
2) Bloods: FBC, U&E, clotting screen
3) ABG (low PaO2, low PaCO2)
4) CXR (normal or dilated pulmonary artery, small pleural effusion, decreased vascular marking,atelectasis)
5) ECG (normal or tachycardia, RBBB)
6) CTPA
7) Or V/Q - ventilation, perfusion scan

Question 8

What does the chest Xray of PE show?

Answer 8

Can be normal or show:

• dilated pulmonary artery
• small pleural effusion
• decreased vascular markings
• atelectasis (collapsed lung)

Question 9

What are the components of Virchow’s triad?

Answer 9

1) blood flow
2) endothelium
3) Blood constituents

(a change in any one of the above can increase risk of clot formation)

Question 10

What are the risk factors of PE - (same as DVT thrombosis formation) ?

Answer 10

• age
• BMI - obese
• immobility / bedrest >4d
• Pregnancy
• Previous DVT or PE
• Oestrogen (OCP or HRT)
• Trauma or surgery to lower limb
• malignancy
• Cardiac / resp failure
• MI / stroke
• infection

Blood conditions:

• sickle cell
• thrombophilia
• Protein C or S deficiency
• Plasminogen deficiency
• Factor V leiden

Question 11

What is the immediate treatment for PE?

Answer 11

• 15L high flow O2
• analgesia (morphine + antiemetic)
• IV fluid
• immediate thrombolysis (50mg bolus of alteplase)
• IVE heparin (LMWH e.g. tinzaparin)

Question 12

What is the prophylactic management of PE?

Answer 12

• Anticoagulant - LMWH and warfarin (until INR > 2-3), then only warfarin for months.
• compression stockings