PE Flashcards
(14 cards)
What is a PE?
Thrombus is pulmonary arteries
An embolus is a thrombus that has travelled in the blood, often from a deep vein thrombosis (DVT) in a leg
thrombus will block the blood flow to the lung tissue and strain the right side of the heart
What are some risk factors for developing a PE?
Immobility
Recent surgery
Long-haul travel
Pregnancy
Malignancy
Hormone therapy w/ oestrogen (COCP, HRT)
Polycythaemia
SLE
Thrombophilia
What is used for prophylaxis of VTE?
Anti-embolic compression stockings
low molecular weight heparin
How may PE present?
Shortness of breath
Cough
Haemoptysis
Pleuritic chest pain (worse on inspiration)
Hypoxia
Tachycardia
Raised RR
Low-grade fever
Hypotension
signs and symptoms of a deep vein thrombosis, such as unilateral leg swelling and tenderness
What score can be used to predict likelihood of patient having PE?
Wells score - is used when PE is suspected
Score >=4 PE likely - do CTPA
Score <4 PE unlikely - Do D-dimer, if +ve then do CTPA
How is a PE diagnosed?
CXR - rule out other pathology
Wells score done - CTPA or D-dimer done
If pt can’t have CTPA, do V/Q scan
What might an ABG look like in patient with PE?
respiratory alkalosis
Hypoxia causes a raised respiratory rate. Breathing fast means they “blow off” extra CO2. A low CO2 means the blood becomes alkalotic. The other main cause of respiratory alkalosis is hyperventilation syndrome. Patients with PE will have a low pO2, whereas patients with hyperventilation syndrome will have a high pO2
What is the immediate management of PE?
Supportive:
O2 if req
Admit to hospital if req
Analgesia
Monitoring
treatment-dose apixaban or rivaroxaban as first-line. Low molecular weight heparin (LMWH) is the main alternative - start if theres a delay to scan
What is a massive PE and what is the management?
PE leading to haemodynamic compromise
continuous infusion of unfractionated heparin and considering thrombolysis
There are two ways thrombolysis can be performed:
- Intravenously using a peripheral cannula
- Catheter-directed thrombolysis (directly into the pulmonary arteries using a central catheter)
What is the long term management for patients with PE?
Long-term anticoagulation - DOAC, Warfarin or LMWH
3 months with a reversible cause (then review)
Beyond 3 months with unprovoked PE, recurrent VTE or an irreversible underlying cause (e.g., thrombophilia)
3-6 months in active cancer (then review)
When are DOACs contraindicated?
severe renal impairment (creatinine clearance less than 15 ml/min)
antiphospholipid syndrome - use warfarin
pregnancy - use LMWH
What are some other conditions that may cause a raised d-dimer?
Pneumonia
Malignancy
Heart failure
Surgery
Pregnancy
What are some absolute contraindications for thrombolysis?
Haemorrhagic stroke or Ischaemic stroke < 6 months
CNS neoplasia
Recent trauma or surgery
GI bleed < 1 month
Bleeding disorder
Aortic Dissection
What are come relative contraindications for thrombolysis?
Warfarin / DOAC
Pregnancy
Advanced Liver Disease
Infective Endocarditis
