Venous Thromboembolism (Pulmonary Embolism)

Question 1

Define pulmonary embolism

Answer 1

An obstruction within the pulmonary arterial tree

Question 2

Describe the pathophysiology of PE

Answer 2

A Pulmonary Embolism is the obstruction of the blood vessels in the lungs

Question 3

What is a PE caused by?

Answer 3

• Thrombosis
• Fat (following surgery/long bone fracture)
• Amniotic fluid
• Air (following neck vein cannulation/trauma)

Question 4

What are symptoms of PE?

Answer 4

• Shortness of Breath
• Chest Pain
• Cough
• Dizziness
• Leg swelling/pain
• Coughing up blood
• Raised Respiratory Rate
• Fever

Question 5

What are risk factors of PE?

Answer 5

• Immobility
• Surgery
• Trauma
• Pregnancy
• Smoking
• Increasing Age
• Obesity
• Clotting disorders
• Recent Long-Haul Travel
• Oestrogen Hormone Therapy

Question 6

What are signs of PE?

Answer 6

• Tachypnoea and tachycardia
  Hypoxia
• DVT (swollen tender calf)
• Pyrexia
• Hypotension (SBP <90 mmHg suggests massive PE)
• Elevated JVP (suggest Cor Pulmonale)

Question 7

What is used to diagnose PE?

Answer 7

A chest x-ray is used in all suspected PE patients to rule out other pathology

Question 8

What is the Wells score?

Answer 8

• Determines the probability of a patient having a PE
• It is used when a PE is suspected
• It accounts for a long list of risk factors and clinical findings

Question 9

What is used to diagnose once a Wells score is calculated?

Answer 9

• If PE is likely -> CT pulmonary angiogram (CTPA)
• If PE is unlikely -> perform a d-dimer, if positive then do a CTPA

Question 10

What is a D-Dimer test?

Answer 10

A d-dimer is a blood test for a venous thromboembolism (VTE)

Question 11

What are other general investigations for PE?

Answer 11

ECG
Arterial Blood Gases

Question 12

What is the treatment for acutely unwell PE?

Answer 12

• Oxygen 100%
• Give analgesia (morphine)
• Assess circulation

Question 13

What is the long term treatment for PE?

Answer 13

• DOACs – Oral Anticoagulants
• Warfarin
• LMWH – Low Molecular Weight Heparin

Question 14

How long do you continue anticoagulation treatment for?

Answer 14

• 3 months with a reversible cause
• Beyond 3 months with unprovoked PE, recurrent VTE or an irreversible underlying cause
• 3-6 months in active cancer
• Then review the treatment and adjust accordingly