PE

Question 1

risk factors for PE?

Answer 1

Immobility
Recent surgery
Long haul flights
Pregnancy
Hormone therapy with oestrogen
Malignancy
Polycythaemia
Systemic lupus erythematosus
Thrombophilia

Question 2

what do you give prophylactically for DVT/PE?

Answer 2

LMWH i.e enoxaparin

contraindications: active bleeding or existing anticoagulation

Question 3

PE presentation

Answer 3

Shortness of breath
Cough with or without blood (haemoptysis)
Pleuritic chest pain
Hypoxia
Tachycardia
Raised respiratory rate
Low grade fever
Haemodynamic instability causing hypotension

Question 4

Blood status in PE?

Answer 4

respiratory alkalosis

Question 5

when do you give LMWH?

Answer 5

antiphospholipid syndrome, pregnancy or cancer

Question 6

initial management of PE?

Answer 6

apixaban or rivaroxaban

Question 7

continue anticoagulation for?

Answer 7

3 months if there is an obvious reversible cause (then review)
Beyond 3 months if the cause is unclear, there is recurrent VTE or there is an irreversible underlying cause such as thrombophilia. This is often 6 months in practice.
6 months in active cancer (then review)

Question 8

when do you thrombolyse?

Answer 8

massive PE with haemodynamic compromise i.e stroptokinase, alteplase, tenecteplase

through cannula or catheter

Question 9

PE changes on ECG?

Answer 9

sinus tachycardia, S1Q3T3, right bundle branch block and right axis deviation

Question 10

possible finding on CXR for PE?

Answer 10

wedge shaped opacification

Question 11

what can you see on CTPA?

Answer 11

saddle embolus

Question 12

what tool do you use to assess risk of bleeding?

Answer 12

ORBIT