PULMONARY THROMBOLISM Flashcards
what is the most common preventable cause of death in
hospitalized patients
PE(Triad of Virchow)
Hypercoagulability
Stasis to flow
Vessel injury
risk factors of PE?
● Malignancy
● Nonmalignant thrombophilia Pregnancy
● Anti cardiolipin ab
● Nephrotic syndrome
● IBD ● PNH ● DIC ● Essential thrombocytosis
(80%–95%) of PE occur as a result of thrombus
originating in t h e (lower/upper) extremity.
lower
PE presents 3-7 days after ……….
DVT
Clinical presentation of PE?
● The Classic Triad: (Hemoptysis, Dyspnea,
Pleuritic Pain)
Pulmonary Infarction -have pleuritic chest pain
● Submassive Embolism
● Massive Embolism -a clot which obstructs two
lobar arteries, so-called “Saddle Embolus”.Acute cor
pulmonale
WHAT are the symptoms of PE(angio)
Dyspnea
Chest Pain, pleuritic
Anxiety
Cough
Hemoptysis
Sweating
Chest Pain, nonpleuritic Syncope
Signs with Angiographically Proven PE
Tachypnea > 20/min Rales Accentuated S2 Tachycardia >100/min Fever > 37.8 Diaphoresis S3 or S4 gallop Thrombophebitis Lower extremity edema
imaging study of PE
CXR
● HRCT
● CTPA
● Pulmonary Angiography
● Duplex USG
Westermark’s sigN
A dilation of the pulmonary vessels proximal to the
embolism along with collapse of distal vessels, sometimes with a sharp cutoff.
Hampton’s H u m p
A triangular or rounded pleural-based infiltrate with
the apex toward the hilum, usually located adjacent to
the hilum.
V/Q scan preferred test in who?
Preferred test in pregnant patients, renal
dysfunction
what is the gold standard of DX OF PE?
Pulmonary Angiography
TREATMEN OF PE
● Anticoagulants
HEPARIN(Will not work in patients with antithrombin III def.
In this case use hirudins)(80 units/kg bolus, 18 units/kg/hr)( LMWH (Lovenox) prefered in pregnant patients
