40: Pulmonary Embolism - Kersenbrock Flashcards
(21 cards)
exogenous or endogenous material migration to the pulmonary vasculature causing various degrees of obstruction
pulmonar embolism
___ % of untreated DVT leads to PE
10-30%
patient with recent fracture…
fat droplet etiiology of PE
virchow’s triad
- hypercoagulability
- endothelial damage
- venous stasis
symptoms of PE
- tachypnea
- hypoxemia
- chest or pleuritic pain
- dyspnea
- anxiety
- cough
- tachycardia
what type of HF can result from PE?
right heart failure
- when the RV can’t genereate enough pressure in systole to push the clot further into the branched vascular bed, it weakens with resultant RHf
what D- dimer level would indicate a PE?
d-dimer level is 550 or greater, the sensitivity for presence of PE may be as high as 98%
a negative d-dimer doesn’t rule out PE if they are deemed high or moderate risk
troponin and PE>
may be elevated if RV has been stressed
ECG changes with PE
sinus tachycarida
-S1Q3T3
what is S1Q3T3?
s wave in lead I
q waves in lead III
inverted t waves in lead III
may indicate PE
CXR reveals: a peripheral conical density with the base opposed to the chest wall
hamptom hump –> on CXR indicates PE
primary diagnositc method for suspected PE
CT angiography CTA
what do you need to check before ordering a CTA?
kidney function – get a BMP
pt has renal failure and suspected PE – what imaging can you use?
ventialtion-perfusion scan
normal scan can exclude PE but not very sensitive to diagnosis
“gold standard” for PE diagnosis
pulmonary arteriography
reserved for pts w/ whom uncertainty remains after CTA
treat stable pt with PE =
- anticoagulation with heparin
- warfarin started at same time as heparin
treat hemodynamically unstable pt with PE =
- thrombolytic therapy followed by anticoaglation
contraindications for thrombolytics?
intracranial bleeds
anything that might break open and bleed
also HTN over 180/100
no preggers
how long is anitcoagulation continued post PE?
3 months
longer with greater risks
clinical suspicion is low and d-dimer is negative =
no further testing needed, not a PE
CTA and d-dimer are negative/nondiagnostic and suspicion is low =
no further testing needed
if suspicion is hgih a leg study should be considered or pulmonary arteriography
