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Respiratory > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

1
Q

What is a Pulmonary Embolism?

A

A condition where a blood clot (thrombus) forms in the pulmonary arteries.

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2
Q

How is a pulmonary embolism usually caused?

A

A deep vein thrombosis (DVT) develops in the legs and travels (embolised) through the venous system and the right side of the heart to the pulmonary arteries in the lungs.

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3
Q

What are the consequences of the pulmonary arteries bceoming blocked?

A

The blood flow to the lung tissue is blocked and this creates strain on the right side of the heart.

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4
Q

What are potential risk factors for the development of a pulmonary embolism?

A
  • Immobility
  • Recent surgery
  • Long haul flights
  • Pregnancy
  • Hormone therapy with oestrogen
  • Malignancy
  • Thrombophilia
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5
Q

How does a pulmonary embolism usually present?

A

chest pain- pleuritic
dyspnoea
haemoptysis
tachycardia
tachypnoea
Haemodynamic instability causing hypotension

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6
Q

What additional signs can present with a PE?

A

Signs of a DVT (unilateral leg swelling and tenderness)

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7
Q

What is the initial investigation for someone presenting with a potential PE?

A

Preform a WELL’s score

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8
Q

What is the next step if the WELL’s score indicates that a PE is likely?

A

CTPA

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9
Q

What is the next step if the WELL’s score indicates that a PE is unlikely?

A

Arrange a D-dimer
If that is positive then carry out a CTPA

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10
Q

What is the first line management of a pulmonary embolism?

A

DOAC’s

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11
Q

What are examples of DOAC’s

A

Apixaban
Rivaroxaban

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12
Q

How long are patients with a PE given DOAC’s if it is an provoked VTE?

A

3 months

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13
Q

What is an alternative to DOAC’s for people with PE’s?

A

LMWH
enoxaparin or dalteparin

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14
Q

What is the management of a massive PE where there is circulatory failure (e.g. hypotension)?

A

Thrombolysis

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15
Q

What is the management of a patient with a PE and renal impairment (< 15/min)?

A

LMWH, unfractionated heparin or LMWH followed by a VKA

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16
Q

What is the manage of a patient with a PE and antiphospholipid syndrome?

A

LMWH followed by a VKA

17
Q

How long are patients with a PE given DOAC’s if it is an unprovoked VTE?

A

A further 3 months (6 months total)

18
Q

What might be considered for a patient with repeat pulmonary embolisms despite adequate anticoagulation?

A

Inferior vena cava (IVC) filters

19
Q

Why would a patient be allocated 3 points on the WELL’s score?

A

Clinical signs and symptoms of a deep vein thrombosis (DVT)

If no alternative diagnosis is more likely than a PE

20
Q

Why would a patient be allocated 1.5 points on the WELL’s score?

A

Tachycardia

Patient has been immobile for more than 3 days or had major surgery within the last month

If the patient has had a previous PE or DVT

21
Q

Why would a patient be allocated 1 points on the WELL’s score?

A

Patient has haemoptysis

If there is an active malignancy

22
Q

What is the next step if the patients WELL’s score is less than 4?

A

Measure D-dimer

23
Q

Why should a D-dimer only be used if the clinical suspicion of a PE is low?

A

It has a high negative predictive value but a low specificity

24
Q

What does a low d-dimer exclude?

A

A PE

25
Q

What is a high d-dimer an indication for?

A

Diagnostic imaging (by CTPA or V/Q scan).

26
Q

What is the next step if the WELL’s score is more than 4?

A

Diagnostic imaging (by CTPA or V/Q scan).

27
Q

What is usually given

A
28
Q

What is the classic triad of symptoms of a PE?

A

SOB
Haemoptysis
Pleuritic chest pain

29
Q

What are the main signs of a pulmonary embolism?

A

Tachycardia
Tachypnoea
Hypoxia

30
Q

What can be the only presenting sign of a PE?

A

Tachycardia

31
Q

What should all patients in hospital at risk of a VTE be given?

A

prophylaxis with a low molecular weight heparin such as enoxaparin

32
Q

What other investigations can be carried out for a PE?

A

ECG
Chest x-ray

33
Q

What might you find on a chest x-ray of someone with a PE?

A

Usually normal
Sometimes see a wedge-shaped opacification

34
Q

What ECG change is associated with a PE but rarely seen?

A

S1Q3T3

35
Q

What is S1Q3T3?

A

Large S wave in lead I
Large Q wave in lead III
Inverted T wave in lead III

36
Q

What are other ECG chnages are associated with a PE?

A

Sinus tachycardia- MAIN
right bundle branch block and right axis deviation- if

37
Q

When might a V/Q scan be done rather than a CTPA?

A

Renal impairment
Contrast allergy
At risk from radiation

38
Q

How long should patients be given anticoagulation if there is an ongoing cause (e.g. a thrombophilia)?

A

Life long

Respiratory (47 decks)

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