Workshop: Treatment of pulmonary embolism

Question 1

What is a pulmonary embolism?

Answer 1

A thrombus that forms in the pulmonary arteries

Question 2

What are the risk factors for pulmonary embolisms?

Answer 2

• Recent surgery
• Long flights
• Pregnancy
• Hormone therapy with oestrogen
• Malognancy
• Polycythaemia
• Systemic lupus erythematosus
• Thrombophilia

Question 3

What is given for prophylaxis of pulmonary embolisms?

Answer 3

LMWH - Enoxaparin

Question 4

How is a pulmonary embolism diagnosed

Answer 4

maging tests: These tests are often the first step in diagnosing a PE. The most commonly used imaging tests for PE are computed tomography pulmonary angiography (CTPA) and ventilation-perfusion (V/Q) scan. A CTPA uses contrast dye and X-rays to create detailed images of the lungs, while a V/Q scan uses a radioactive tracer to measure blood flow and air movement in the lungs.

Blood tests: A blood test to measure the D-dimer level is often used to help diagnose or rule out a PE. Elevated D-dimer levels can be an indicator of a blood clot in the body. However, D-dimer levels can also be elevated in other medical conditions, so further testing is needed to confirm the diagnosis.

Question 5

How do you manage pulmonary embolisms?

Answer 5

• Admission to hospital
• Oxygen
• Analgesia for pain
• Monitor for detrioration
• Apixiban
• Thromolbytic agent therapy with alteplase – thrombolysis. 10mg over 1 – 2 minutes and 90mg over two hours
• Anticoagulant for prevent getting another clot and disolve any clot still there.

Question 6

What is the counselling for anticoagulants?

Answer 6

• High risk drug
• Take apixaban 10mg twice a day morning and nigh for 7 days only and then 5mg twice daily for maintenance.
• Side effects are increased risk of bleeding nose, black stools, blood in urine, bruising.
• NSAIDA CAN HAVE INTERACTION with apixaban.
• Do not use miconazole and warfarin.
• Anticoagulant card – let dentist other healthcare professionals know of their treatment.
• Pregnancy should be avoided – contraindication.
• Do not take double dose f they forget to take it. - Apixaban is shoirt acting – not longer anticoagulated if they miss two doses – cpliance is important