Pulmonary Venous Thromboembolism Flashcards
What is the most common type of emboli?
Thromboembolism
What is Virchow’s Triad?
Venous Stasis
Vessel Injury
Hypercoagulability
What are the Inherited risk factors for a Pulmonary Embolism?
Factor V Leiden
Prothrombin Gene Mutation
What are the Provoking (Acquired) risk factors for a Pulmonary Embolism?
Recent Surgery
Trauma
Immobilization
Hormone Therapy
Active Cancer
What are the Non-Provoking (Acquired) risk factors for a Pulmonary Embolism?
Obesity
Heavy Cigarette Smoking
Where do most emboli arise from before becoming a pulmonary embolism?
Lower Proximal Veins
- Iliac
- Femoral
- Popliteal
What is most commonly used to quantify clinical risk assessment and calculate probability of a pulmonary embolism?
Wells Score
Wells Score
Leg Swelling + Pain with Palpation of Deep Veins - 3.0
Alternative Diagnosis is less likely than PE - 3.0
Heart Rate > 100 - 1.5
Immobilization for 3 days or surgery in last 4 weeks - 1.5
Previous PE or DVT - 1.5
Hemoptysis - 1.0
Cancer - 1.0
May be used to identify patients for whom no further testing is indicated.
Pulmonary Embolism Rule-out Criteria
(PERC)
PERC Score
Age 50+
HR 100+
O₂ Sat. < 95%
Unilateral Leg Swelling
Hemoptysis
Recent Surgery or Truma
Prior PE or DVT
Hormone Use
PERC Rule if No Criteria are met.
No further work-up
PERC Rule if 1 Criteria met.
D-Dimer
What to do with positive D-Dimer?
CT PE
What is the diagnostic test of choice for a pulmonary embolism?
CT PE
EKG findings of a patient with a Pulmonary Embolism
S1Q3T3
Chest X-Ray findings of a patient with a Pulmonary Embolism
Wedge-Shaped Infiltrate
Profound hypoxia with a normal Chest X-Ray is highly suspicious of?
Pulmonary Embolism
What is the first line imaging used for a Pulmonary Embolism?
CT Scan
What can be used in patients who you suspect have a PE but have an intolerance to contrast?
V/Q Scan
High Risk or Massive PE
Hemodynamically Unstable
- BP < 90 or drops by > 40mmHG below baseline for 15 minutes.
- HR < 40
- Pulselessness
Acute PE without systemic hypotension BUT with either Right Ventricular Dysfunction or Myocardial Necrosis.
Submassive or Intermediate PE
What type of PE is associated with the highest mortality.
In Transit through the Heart
Where do most PEs move to?
Lobar, Segmental, and Subsegmental Branches of Pulmonary Artery
What should you start immediately in a patient with a PE?
Heparin drip
