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Respiratory System > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

1
Q

What are the types of embolism?

A

Thrombus
Fat
Air
Amniotic fluid
Foreign material

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2
Q

What is a venous thromboembolism?

A

Embolism caused by thrombus formed in the venous system e.g. DVT

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3
Q

What is an embolism?

A

Obstruction of a blood vessel

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4
Q

What will happen to thrombi from a systemic vein?

A
  • travels though the right side of the heart
  • impacts the lungs
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5
Q

What is part of virchow’s triad?

A
  • haemodynamic changes: stasis/turbulence
  • hypercoagulability
  • vessel wall damage
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6
Q

What is the highest risk factor of pulmonary embolism?

A

Increasing age

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7
Q

What can cause vessel wall damage?

A
  • vascular access
  • injury/trauma
  • varicose veins
  • increasing age
  • surgery
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8
Q

What are causes for haemodynamic changes?

A
  • prolonged immobility
  • pregnancy
  • obesity
  • varicose veins
  • increasing age
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9
Q

What are causes for hypercoagulability?

A
  • thrombophilia - high platelets
  • oestrogen containing meds
  • cancer
  • smoking
  • pregnancy
  • obesity
  • increased age
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10
Q

What are the three main impacts of pulmonary embolisms?

A

Acute right heart strain
Respiratory failure
Pulmonary infarction

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11
Q

How do pulmonary embolism cause acute right sided heart failure?

A
  • increased pressure in pulmonary artery
  • causes RV dilatation > acute right sided heart failure
  • inotropes released to maintain systemic BP
  • causes vasoconstriction of pulmonary artery
  • increases pressure even more
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12
Q

Symptoms of a pulmonary embolism

A
  • dyspnoea
  • pleuritic chest pain
  • cough
  • syncope
  • haemoptysis
  • unilateral leg pain/swelling (DVT)
  • diaphoresis
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13
Q

How can pulmonary embolisms cause pulmonary infarction?

A
  • small emboli cause alveolar haemorrhage + infarction of lung tissue
  • causes haemoptysis, pleuritis + small pleural effusion
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14
Q

How do pulmonary infarction appear on a CXR?

A

Wedge or Hampton hump

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15
Q

What are the classic findings on an ECG of a patient with pulmonary embolism?

A

sinus tachycardia
SI QIII TIII
- Deep S wave in lead I
- Pathological Q wave in lead III
- Inverted T wave in lead III

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16
Q

A PE can be ruled out if patient is D dimer … and … risk

A

A PE can be ruled out if patient is D dimer negative and low risk

17
Q

When is a D dimer test useful for PE?

A

Only when a patient is at a low risk of PE
(Negative test = rules out PE)
Well’s score <4

18
Q

How do we decided if a patient is at high or low risk of a pulmonary embolism?

A

Well’s score

19
Q

Treatment of pulmonary embolisms

A
  • start with O2
  • treat the source: anticoagulants, mechanical removal, thrombolysis
20
Q

When patients are discharged after a PE they are normally switched to a oral anticoagulant, how long do they need this for?

A
  • 3 months if identifiable temporary risk factor
  • indefinitely if no identifiable risk factor
21
Q

What is the first line drug treatment of a PE?

A

Low molecular weight heparin

22
Q

Prevention of pulmonary embolisms

A
  • anticoagulants
  • mobilisation
  • TED stockings/AES
  • intermittent pneumatic compression
  • fall prevention
  • avoid unnecessary invasive procedures
23
Q

What is the normal level for D dimer?

A

0.5

24
Q

How can pulmonary embolisms cause respiratory failure?

A
  • low RV output
  • reduced perfusion to lungs
  • V/Q mismatch
  • low pO2
25
Q

What is diaphoresis?

A

Sweating

26
Q

Imaging of pulmonary embolisms

A

CT pulmonary angiogram
CXR
V/Q scan

27
Q

Further treatment of pulmonary embolism in severe cases

A

Haemodynamic support
Respiratory support
Surgical intervention

28
Q

How does heparin induced thrombocytopenia occur?

A
  • antibodies form against heparin
  • bind to heparin platelet complexes
  • platelets become activated + clump together
  • thrombi form
  • thrombi spread through body
  • risk of causing stroke, MI + limb ischameia
29
Q

What is a pulmonary embolism?

A

Material that has moved from one part of vasculature through right side of heart + lodges in pulmonary arteries

30
Q

What % of PEs arise from DVTs?

A

90%

31
Q

Signs of pulmonary embolism

A
  • dyspnoea
  • tachycardia
  • Tachypnoea
  • low BP
  • raised JVP
32
Q

Main differential diagnosis for PE

A
  • pneumothorax
  • pneumonia
  • MSK chest pain
  • MI
33
Q

Investigations of PE

A
  • ABG: shows respiratory alkalosis
  • chest X ray: exclude differentials
  • ECG: sinus tachycardia SI QIII TIII
  • D dimers
  • Wells score
  • CT pulmonary angiogram
  • V/Q scan
34
Q

Why is distended neck veins (raised JVP) a sign of PE?

A

Increased pulmonary artery pressure
More difficult for RV to empty

IJV drains into subclavian vein > superior vena cava > right side of the heart

Respiratory System (20 decks)

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