Clinical Perspective of Pulmonary Embolism

Question 1

What is the treatment for a PE/DVT?

Answer 1

Heparin (UFH or LMWH) and warfarin

Question 2

Patients with a PE often present with what acid/base imbalance?

Answer 2

Respiratory alkalosis - due to tachypnea

Question 3

What is the antidote for unfractionated heparin?

Answer 3

Protamine sulfate

Question 4

Warfarin must be overlapped with another anticoagulant over several days. Why is this?

Answer 4

Proteins C & S are anticoagulants that are first to be inactivated by warfarin resulting in a transient hypercoagulable state

Question 5

What is the gold standard diagnosis method for a PE?

Answer 5

Pulmonary arteriography

Question 6

What is the MOA of dabigatran?

Answer 6

Direct thrombin inhibitor

Question 7

Well’s criteria predicts the clinical probability of a PE. What score indicated high suspicion?

Answer 7

4+

Question 8

True/Flase. A positive D-dimer is diagnostic of a PE.

Answer 8

False. The test is sensitive, but not specific. It is more helpful to rule out a PE.

Question 9

What is the treatment for a hemodynamically unstable patient with a confirmed PE?

Answer 9

t-PA or other thrombolytic (streptokinase and urokinase)

Question 10

What is the first imaging study ordered on a patient with abnormal D-dimer suspected of having a PE?

Answer 10

Spiral CT (CT angiogram)