RRAPID: Pulmonary Embolism Flashcards
Risk factors? (11)
Malignancy Post-surgery Immobility OCP Pregnancy Previous DVT/PE Increasing age Obesity Smoking Infection Dehydration
Features?
Sudden onset of SOB Pleuritic chest pain Haemoptysis Syncope Tachycardia Hypotension Raised JVP Hypoxia
Initial diagnostic criteria?
Wells Score
Well Score criteria?
Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins) = 3
An alternative diagnosis is less likely than PE = 3
Heart rate > 100 beats per minute = 1.5
Immobilisation for more than 3 days or surgery in the previous 4 weeks = 1.5
Previous DVT/PE = 1.5
Haemoptysis = 1
Malignancy (on treatment, treated in the last 6 months, or palliative) = 1
What values are high risk and low risk Wells Scores?
High risk: > 4 points
Low risk: <= 4 points
What other criteria can be used?
PERC Criteria
PERC Criteria?
H – hormone use
A - age >50yrs
D – DVT/PE history
C – Coughing up blood
L – Unilateral Leg swelling
O – Oxygen sats <95%
T – Tachycardia >100
S – Surgery or trauma
1st line invesitigation if WELLS score > 4 (high risk)?
CTPA (CT pulmonary angiography)
1st line investigation if WELLS score <= 4 (low risk)?
D-Dimer
What is D-Dimer a measure of?
Fibrin degradation product
When is not useful to measure D-Dimer? (4)
Pregnancy
After major surgery
After trauma
After severe infection (e.g. sepsis)
If D-Dimer negative what does that mean?
PE can be excluded
If D-Dimer is postive what does that mean?
Furher CTPA is required
Response (Airway)? (2)
Sit patient up
Give O2 15L/min via resovioir mask
Response (Breathing)?
ABG
CXR (often normal)
