VTE

Question 1

Imaging modality to use in a suspected PE in a patient with renal impairment?

Answer 1

Ventilation perfusion scan

Rather than a CTPA with contrast media.

Question 2

What are the features in the wells score for PEs and how many points each?

Answer 2

Clinical signs and symptoms of DVT (3)
An alternative diagnosis is less likely than PE (3)
HR > 100bpm (1.5)
Immobile > 3 days or surgery in past 4 weeks (1.5)
Previous DVT/PE (1.5)
Haemoptysis (1)
Malignancy (now or within last 6 months) (1)

Score >4 PE is likely do CTPA (give LMWH if delay)
Score <4 PE is unlikely do d-dimer, if positive do CTPA (give LMWH if delay)

Question 3

What is seen on ECG in someone with a PE?

Answer 3

Classically S1Q3T3,
Also
RBBB and RA deviation
Tachycardia

Question 4

Management of PE

Answer 4

Intaillly - LMWH or fondaparinux
Within 24 hours warfarin should be given (continue LMWH or F until INR stable or 5 days)
Warfarin for 3 months (if provoked) longer if unprovoked.
Patients with active cancer - 6months of LMWH

Question 5

What INR do you aim for if there is a DVT on warfarin 2.5?

Answer 5

INR 3.5

Question 6

ABG in PE normal shows what?

Answer 6

Resp alkalosis - tachypnoea

Question 7

When is thrombolysis indicated in a PE? What the other treatment if thrombolysis isn’t incidated?

Answer 7

Massive PE with hypotension (circulatory failure) - plus give unfractioned heparin.

Smaller PEs - LMWH or fondaparinux