January 11, 2016 - Pulmonary Embolism Flashcards Preview

COURSE 3 > January 11, 2016 - Pulmonary Embolism > Flashcards

Flashcards in January 11, 2016 - Pulmonary Embolism Deck (16):
1

Why is PE Important?

1. Common

2. Life threatening

3. Can be challenging to diagnose

4. Treatable

2

PE on CT

Large thrombus blocks blood supply. The IV contrast does not reach the parts of the tissue that is blocked off from the PE.

A image thumb
3

Why do PE's Have Different Clinical Presentations?

There is a huge variety of locations for a PE to occur, and a large variety of the size of PEs. Small PEs typically produce less symptoms than large ones.

The right side of the heart can act like a blender and mash up a clot into varying sized pieces, which may become stuck in the lungs.

4

Origins of PE

90% originate from the deep veins in the legs.

The other 10% can occur from upper extremity veins, renal veins, pelvic veins, or the heart.

They do NOT come from superficial veins such as varicose veins or saphenous veins.

5

Signs and Symptoms of a DVT

Red, swollen, warm, tender leg.

Many patients do not have symptoms. You need to investigate further by performing an ultrasound or looking for a D-Dimer.

6

Pathophysiologic Response to a PE

Bilateral perfusion defects

Infarction (although the tissue is more resistant to infarction due to the dual blood supply of both the pulmonary circulation and bronchial artery)

Abnormal gas exchange

Cardiovascular compromise

7

Diagnostic Evaluation of PE

History (HPI, PMHx, Risk Factors)

Physical Exam

Chest X-Rays, ECG

D-Dimer

V/Q Scans

Doppler U/S of Legs

8

Risk Factors for PE

Immobilization

Surgery (within last 3 months)

Malignancy

Stroke

Previous DVT/PE

Smoking

Obesity

Hypertension

Coagulation abnormalities

9

Hampton's Hump

A radiologic sign which consists of a shallow wedge-shaped opacity in the periphery of the lung with its base against the pleural surface.

Can indicate a PE and may also be associated with pleural effusion.

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10

Westermark Sign

A radiographic sign seen in 2% of PE cases. It results as a combination of the dilation of the pulmonary arteries proximal to the embolus and the collapse of the distal vasculature creating the apparearance of a sharp cut off on chest radiography.

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11

Most Common Cause of False + D-Dimer

Pneumonia

12

Estimating Clinical Probability of PE

Well's Score

13

Ventilation/Perfusion (V/Q) Scan

Patient breaths in radiolabelled particles and also has IV radiolabelled dye administered. You then look for unmatched defecits where areas are well-ventilated but there is no perfusion.

In the picture, A is the scan after inhalation of the particles. B is the scan after the radiolabelled dye is administered. You can see in A that the entire lung is well-coated, however in B there are areas where the blood is not well-perfused.

V/Q is useful if the Well's Score is high or if it is low, but not intermediate.

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14

Signs of Massive PE

Severe dyspnea

Syncope

Tachycardia, tachypnea, hypotension, increased JVP, R-sided S3

15

Treatment of PE

Initial and chronic anticoagulation

IVC filter for select indications

For massive PE... Systemic thrombolysis, catheter-directed thrombolysis, or surgical embelectomy.

16

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