trigger - pulmonary circulation disorders Flashcards
PE type resulting from long bone fractures
fat PEs
MC sign and MC symptom of PE
tachypnea and dyspnea
wells criteria of 5
moderate risk
remember:
>6 = high
2-6 = intermediate
<2 = low
what is the next step after determining that the wells score is “low”
use PERC rules! if even one is positive you MUST get D-dimer!
if a patient is 67 what is their expected D-dimer
below 670ng/mL
if patient is above 50, use the equation:
age x 10ng/mL
caution with metformin
CTA
what imaging is used for pregnant patients with suspected PE
VQ scans
area of lung oligemia - usually from complete lobar artery obstruction
westermarks sign
dome-shaped dense opacification in the periphery of the lung. indicative of pulmonary infarction
hamptons hump
what is the risk stratification for high risk PE (massive)
ANY of the following:
- SBP<90 for >15 min
- drop in SBP >40 mmHg below basline
- hypotension requiring vasopressors
- cardiac arrest
risk stratification for intermediate risk PE
- signs of R sided HF
- elevated trop or BNP
what should you NOT do in PE patients d/t risk of right sided HF
give excess IV fluids
binds to and accelerates activity of antithrombin
unfrac heparin
obtain aPTT every 6 hours during tx
unfrac heparin
this anticoagulant is reserved for unstable patients or pateints with severe renal insufficiency
unfrac heparin
dose: 80 units/kg/dose IV then 18units/kg/hour (max 2000)
unfrac heparin
preferred in pts who cant take oral anticoags
LMWH
requires monitoring in obese and underweight patients (<45kg) or patients with renal impairment
LMWH
BID then QD after 21 days
rivaroxaban (xarelto)
which anticoags require bridging
- dabigatran (pradaxa) - 5-10 days w/UFH or LMWH
- warfarin - w/LMWH until INR is 2-3
anticoag with once daily SQ dosing
fondaparinux (arixtra)
pt has intermediate risk with elevated trop and BNP with persistent hypoxia. what is treatment?
tPA!
indicated in high risk
indicated in intermediate w/ elevated trop OR BNP OR hypoxemia w/ distress
pt has an active bleed that prevents use of anticoagulation. what is the treatment for their PE?
IVC filter
what are the WHO pulm HTN classifications
class 1: idiopathic, hereditary, drug induced, cong HD, CTD, or HIV associated
class 2: d/t left sided Heart disease
class 3: d/t lung disease/hypoxia
class 4: d/t chronic thromboembolic pulm HTN
class 5: multiple causes (ex. sarcoidosis)
