[Resp] Pulmonary Embolism Flashcards
what can PEs be defined as?
provoked or unprovoked
what is a provoked PE?
when PE occurs after:
- surgery / trauma in last 3 months
- significant immobility in the last 3 months
- pregnancy / puerperium
- COCP / HRT use
- active cancer
do you need to request further ix in a provoked PE?
no
what is an unprovoked PE?
when there are no risk factors for a PE
in an unprovoked PE, if there are sx consistent with cancer, what should be done next?
- bloods: FBC, U+E, LFTs, clotting and physical exam
- CT TAP
in an unprovoked PE, if there are no sx consistent with cancer, what should be done next?
- bloods: FBC, U+E, LFTs, clotting and physical exam
- consider thrombophilia screen
what is included in a thrombophilia screen?
- anti-phospholipid syndrome
- hereditary thrombophilia (especially in those with unprovoked DVT with FH of 1˚ relative with unprovoked DVT)
what is the most common ECG change in PE?
sinus tachycardia
what are signs of poor Px on ECG for PE?
- new complete/incomplete RBBB
- S1Q3T3 pattern
- right ventricular strain pattern
- atrial arrhythmias
how do you manage PE with haemodynamic instability?
urgent thrombolysis
how do you manage provoked PE if there is a cancer Dx?
6 months DOAC (Apixaban or Rivaroxaban)
how do you manage provoked PE if there is no cancer Dx?
3 months DOAC (Apixaban or Rivaroxaban)
how do you manage unprovoked PE?
6 months DOAC (Apixaban or Rivaroxaban)
the PE Mx for adults does not apply to which group of pts?
- pregnant
- poor renal function
- antiphospholipid
recurrent miscarriages, prolonged APTT and thrombocytopenia. dx?
antiphospholipid syndrome
