Respiratory 10 - Pulmonary Embolism Flashcards
key risk factors for PE / VTE x8
prolonged immobility recent surgery pregnancy cancers thrombophilia any oestrogen therapy obesity fracture
2 things to be done if assessed as increased risk of VTE
contraindications to these
prophylactic enoxaparin (not if active bleeding or already on anticoag) compression stockings (not if peripheral arterial disease)
8 signs + symptoms of PE
SOB cough +/- blood pleuritic chest pain deep inspiration low sats tachycardia high resp rate low fever hypotension
(+/- unilateral leg swelling/pain)
what score is used to assess PE likelihood?
Well’s score
investigating PE
if Well’s likely - CTPA
if Well’s unlikely - do D dimer, if not negative do a CTPA
which various things can raise D dimer?
sepsis, cancer, heart failure, surgery, pregnancy
i.e. anything that can cause fibrin degradation
what 3 reasons would you have for doing a VQ scan and not a CTPA?
can’t have contrast - renal impairment or contrast allergy
at risk from radiation (less exposure than CT)
what ABG findings would you see with a PE?
resp alkalosis
other causes are anything causing hyperventilation (if just hyperventilation syndrome thenO2 levels will be normal)
how do you treat a PE?
oxygen, analgesia, treatment dose enox /dalteparin
define the different time periods a patient would stay on a DOAC after PE
3 months - cause obvious and reversible
6 months - unknown cause, recurrence, thrombophilia, cancer
define a massive PE and how you would treat it
massive PE = haemodynamic compromise
consider thrombolysis (alteplase etc)
can do catheter-directed straight in pulmonary arteries or IV
difficult decision due to higher bleeding risk
