Respiratory - Pulmonary Embolism Flashcards
What are the risk factors for developing a PE?
Immobility
Recent surgery
Long-haul travel
Pregnancy
Contraceptives
SLE
Thrombophilia
What VTE prophylaxis are patients given?
VTE stockings
Higher risk patients are given dalteparin
How do patients with PE present?
SOB
Cough
Haemoptysis
Pleuritic chest pain
Low-grade fever
Tachycardia
Tachypnoea
Hypotension
What is a Wells Score?
Probability of patient having a PE
How is PE diagnosed?
CXR (rule out other pathology)
Use Wells score to determine next step
Likely- CTPA
Unlikely- D-Dimer if positive do CTPA
Why is a D-dimer not confirmation of a PE?
Highly sensitive but not specific
Can be positive but there may be other causes of a raised d-dimer
What are some other causes of a raised d-dimer?
Pneumonia
Malignancy
HF
Surgery
Pregnancy
What imaging is used to diagnose a PE?
CTPA
VQ SPECT scan
What is the management of a pulmonary embolism?
Supportive management
Oxygen
Analgesia
Monitoring
Apixaban or rivaroxaban
What is the management of a massive PE?
Continuous infusion of unfractionated heparin and consider thrombolysis (streptokinase, alteplase)
How is thrombolysis performed?
IV
Catheter-directed thrombolysis, directly into pulmonary arteries using a central line
What is given for long-term anticoagulation?
DOAC (apixaban, rivaroxaban, dabigatran)
Warfarin
LMWH
When is warfarin the first line for long-term anticoagulation?
Antiphospholipid syndrome
When is LMWH used?
First-line for pregnancy
How long is anticoagulation used for?
3 months - reversible cause
Over 3 months- irreversible underlying cause
3-6 months- active cancer
