FN: Pulmonary embolism Flashcards Preview

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Flashcards in FN: Pulmonary embolism Deck (12):
1

Causes

1. Usually arise form DVTs in proximal leg or iliac veins
2. Rarely:ventricle post MI or septic emboli in right sided endocarditis

2

Risk factors

SPASMODICAL
1. Sex: F
2. Pregnancy
3. Age: old
4. Surgery (classically 10d post-op straining at stool)
5. Malignancy
6. OestrogenL OCP/HRT
7. DVT/PE previous Hx
8. Immobility
9. Colossal size
10. Antiphoppholipid Abs
11. Lupus Anti-coagulant

3

Presentation depends on

Symptoms and signs depends on zixe, number and distribution of emboli

4

Symptoms

Dyspnoea
Pleuritic pain
Haemoptysis
Syncope

5

Signs

1. Fever
2. cyanosis
3. Tachycardia, tachypneoa
RHF: hypotension, raised JVP, loud P2
4. Evidence of cause: DVT

6

Investigations

1. Bloods: FBC, U + E, clotting, Ddimers
2. ABG: normal or reduced Pao2 and reduced PaCO2, alkalotic
3. CXR: normal o oligaemia, linear atelectasis (wedge shape)
ECG: sinus tachy, RBBB, right ventricular strain (inverted T in V1-V4)

7

Diagnosis

1. Assess probably using wells score
2. Low-probability --> perform D-dimers
3. high probability: CTPA

8

D-dimers explain

Used in low probablitity
- Negative --> excludes PE
Positive --> CTPA

9

-ve Ddimer

has a 95% NPV for PE

10

Prevention

Risk assessment for all patients
TEDS
Prophylactic LMWH
Avoid OCP/HRT if @ risk

11

Management

1. Oxygen - sit p, 100% oxygen via non-rebreather mask
2. Analgesia
3. If massive consider thrombolysis (ateplase 50mg bolus stat or surgical o interventionl embolectomy
4. LMWH Heparin - enoxaparin 1.5 mg/kg
5. SBP - consider colloid or start warfarin
6. Inotropes if BP still low
7. On going management

12

On going management for PE

1. TEDS in hospital
2. Graduated compression stockings for 2 yrs if DVT: prevent post-phlebitic syndrome
3. Continue LMWH until INR >2
4. Target INR = 2-3
5. Duration depending on cause
6. VC filter if repeat DVT/PE despite anticoagulation

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