Respiratory System - Pulmonary Embolus

Question 1

Define pulmonary embolus?

Answer 1

A mass of material from another area of the body that lodges inside a pulmonary vessel, blocking its lumen

Question 2

What types of emboli are there?

Answer 2

Thromboembolus
Infective vegetations
Atheroma
Fat
Amniotic fluid
Gas
Tumour

Question 3

Which three components create Virchow’s triad?

Answer 3

Clots form as a result of disturbances to:-
Wall (endothelial damage)
Flow (abnormal flow)
Constituents (hyper-coagulability)

Question 4

What are the clinical features of multiple mini PE?

Answer 4

Cor pulmonale - pulmonary hypertension

Question 5

What are the clinical features of a middle sized PE?

Answer 5

Often leads to infarct and necrosis of lung parenchyma

Symptoms = breathlessness/haemoptysis (30%)/pleuritic chest pain

Question 6

What are the clinical features of large PE?

Answer 6

5% of cases = sudden death
Often associated with severe central chest pain
Signs = shocked/pale/sweaty

Question 7

Name the symptoms of PE?

Answer 7

Acute breathlessness
Pleuritic chest pain
Haemoptysis
Syncope and dizziness

Question 8

Name the signs of PE (six)?

Answer 8

Pyrexia
Cyanosis
Tachypnoea
Tachycardia 
Hypotension
Increased JVP

Question 9

Name 9 risk factors associated with PE?

Answer 9

Recent surgery
Immobility
Thrombophillia
Family history of PE
Previous PE
Leg/hip fracture
Malignancy 
Post-partum/pregnancy 
OCT/HRT

Question 10

Name four investigations to identify PE?

Answer 10

D-Dimer - if (-ve) rules out PE
CT-Pulmonary-Angiogram
ECG - “classic” S1Q3T3 (where the T-wave is inverted)
V/Q scan

Question 11

Describe the stepwise management of PE?

Answer 11

All patients should receive high flow 02 - unless chronic lung disease
Anti-coagulation (Heparin) or (Fondaparinux) or (Tinzaparin) given SC - followed by three months of oral (Warfarin)
In patients with massive PE - firbinolytics (Altepase) or (Streptokinase)