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Emergency & Acute > VTE > Flashcards

VTE Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Inpatient VTE prophylaxis: what is it important to know/ ask about?

A

Any current bleeding/ bleeding risk

Weight + renal function (reduced dose if <50kg)

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2
Q

Clinical features of PE

A

Dyspnoea, tachypboea, pleuritic chest pain

May also have features of DVT

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3
Q

Less common features of PE

A

Retrosternal chest pain (due to RV ischaemia)

Cough + haemoptysis

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4
Q 
Signs of PE:
HR
O2 sats
temperature
JVP
Sound
BP
A 
TachyC
Hypoxia
Pyrexia
Raised JVP
Pleural rub
Hypotension
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5
Q

What is a massive PE?

A

Involves both pulmonary arteries OR results in haemodynamic compromise

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6
Q

What is a provoked PE?

Risk of recurrence

A

Associated with a transient RF

RFs can be removed = reduced risk of recurrence

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7
Q

What is an unprovoked PE?

Risk of recurrence

A

No identifiable RFs

Inc risk of recurrence

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8
Q

Pathophysiology of PE

Effect on pulmonary artery

A

Lung tissue is ventilated but not perfused = intrapulmonary dead space + impaired gas exchange

increased pulmonary artery pressure

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9
Q

Most common cause of PE

A

DVT

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10
Q

Other causes of PE (think sources)

A 
Tumours 
Fat 
Amniotic fluid
Sepsis
Foreign body
Air
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11
Q

Tumours most likely to cause PE

A

Prostate + breast

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12
Q

Most common cause of a fat PE

A

long bone fractures

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13
Q

Most common cause of an air PE

A

Surgery

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14
Q

6 major risk factors for PE

A 
DVT (70%)
Active cancer
Recent surgery (last 2 months)
Immobility 
Lower limb trauma/ fracture
Pregnancy + 6 weeks pp
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15
Q

What % of PEs have no identifiable RFs?

A

30-50%

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16
Q

How much does having an active cancer increase the risk of VTE?

A

4 fold risk

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17
Q

Other RFs for VTE

A

Age >60
COCP
Obesity
Long-haul travel/ thrombotic disorders/ varicose veins

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18
Q

Can you see PE on a CXR?

A

No

19
Q

ECG changes in PE

A

Tachycardia

ST + T wave abnormalities

20
Q

Two-level PE wells score (5 components)

A 
Clinical features of DVT
HR >100
Immobilisation >3 days or surgery in last 4 weeks
Haemoptysis
Cancer (in last 6 months)
21
Q

Next step if PE wells score >4
What does this mean?
What if there is a delay?

A

PE likely!!

CTPA

If there is a delay, give immediate LMWH or fondaparinux

22
Q

Give 2 examples of LMWHs

A

Tinzaparin

Enoxaparin

23
Q

If PE wells score is <4
Next step
What does this mean?

A

PE unlikely

Arrange a D dimer

24
Q

Next stages after D dimer
Positive
Negative

A

Pos: CTPA

Neg: consider alternative diagnosis

25
Q

What is a D dimer?

A

Protein fragments released when a blood clot breaks down

26
Q

D dimer has a negative predictive value - what does this mean?

A

Normal D dimer = PE is unlikely

BUT lots of other factors can cause a high D dimer (i.e. low PPV)

27
Q

Other factors causing a high D dimer

A

Pregnancy, cancer, inflammation

28
Q

Mx of PE

A

ANTICOAGULATE!!

LMWH/ fondaparinux/ oral anticoagulant

29
Q

Mechanical interviention if recurrent PE likley

A

IVC filter

30
Q

When is thrombolysis indicated

A

THROMBOLYSIS = FIRST LINE FOR MASSIVE PE

31
Q

Example of thrombolysis
How is it given?
Dose

A

50mg bolus of ALTEPLASE, followed by IV infusion

32
Q

When should thrombolysis be delivered?

A

Within 4.5 hours of onset

33
Q

Contraindications for thrombolysis (6)

A 
PMH of intracranial haemorrhage
Brain tumour
Stroke in last 3 months
Suspected dissection
Recent surgery
Recent head trauma
34
Q

What is a long-term complication of DVT?

A

Post-thromboticc syndrome (lifelong pain + swelling of the leg)

35
Q

Presentation of DVT

A

Swollen, red, painful, tender leg
Dilated superficial veins

N.B. small/ partially-occluding thrombus may be asymptomatic

36
Q

Wells sore for DVT (7)

A 
Active cancer in last 6 months
Recent immobilization
Localised tenderness
Entire leg is swollen
Calf swollen >3cm more than other leg
Pitting oedema
Collateral superficial veins
Previous DVT
37
Q

Wells score results

A

2+ DVT likely

1 point or less = DVT unlikely

38
Q

Next stage if DVT likely after wells score

What if this can’t be arranged within the time frame?

A

Proximal leg vein USS within 4 hours

If can’t be carried out, do a D Dimer + give 24 hr dose of parenteral anticoagulant

39
Q

Next stage if DVT unlikely after wells score

A

D-dimer

40
Q

D-dimer:
Positive
Negative

A

Positive: USS within 4 hours
Negative: consider alternative diagnosis

41
Q

Initial management of DVT

A

LMWH + arrange outpatient follow-up

42
Q

Duration of treatment following a DVT

A

3 months

43
Q

DDx: superficial thrombophlebitis

A

Painful, tender area of skin
Firm superficial vein + overlying erythema
(N.B. may co-exist with DVT)

Emergency & Acute (21 decks)

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