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Disease II > PE > Flashcards

PE Flashcards

1
Q

Define an embolus

A

A mass that can move forward.

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2
Q

Other names for a thrombus

A

Blood clot

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3
Q
A
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4
Q

What can be PE

A

Tumor
Blood clot
Air
Fat

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5
Q

Name the different types of embolisms

A

Saddle
Lobar
Segmental
Sub-segmental

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6
Q

What are the adverse effects of reduced perfusion to the lungs

A

Decreased surfactant production

Decreased lung compliance/atelectasis

Further mismatch

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7
Q

Clot formations/ virchow’s triad

A

Venous stasis

Hypercoagulability

Injury of endothelial cells

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8
Q
A
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9
Q

What does a “stitch in your side indicate” ?

A

Potentially a PE

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10
Q

How do tumors cause PE’s

A

Multiple myeloma causes bones to brake off

Tumors can release procoagulants

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11
Q

What causes venous stasis

A

Immobility
Ex. Long flights

medical conditions

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12
Q
A
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13
Q

How does pregnancy cause PE

A

Obstruction of venous return by enlarged uterus

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14
Q

Why are hospitalized patients at risk of a PE

A

Immobilized by sickness

Maybe on a vent

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15
Q

What surgeries have a high risk for PE

A

Hip surgery
Pelvic surgery
Knee surgery

Some obstetric or gynecologic procedures

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16
Q

What types of trauma can cause a PE

A

Bone fracture of lower extremities

Extensive injury of soft tissue

Postoperative or postpartum states

Extensive hip or abdominal operation

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17
Q

Vascular conditions that cause venous stasis

A

CHF
Varicose veins
Thrombophlebitis

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18
Q

Risk factors for hypercoagulation

A

Oral contraceptives (increase clotting factor)

Polycythemia

Factor V Leiden

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19
Q

Risk factors for endothelial damage

A

Smoking

Hypertension

Atherosclerosis

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20
Q

What is the presentation with a massive PE

A

Sudden onset

Enormous reduction in BP and oxygenation

Quick fatality

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21
Q

How long might it take people to present symptoms of a PE

A

Days or weeks

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22
Q

What classifies a massive PE

A

Equal or greater than 50% vascular occlusion and vasoconstriction

Decreased (LV) and (RV) output

Systematic hypotension

Cardiovascular collapse

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23
Q

Presentation for a massive PE

A

Sudden dyspnea

Tachycardia

Hypotension

Hemodynamic instability

Pleuritic chest pain (may radiate)

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24
Q
A
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25
How does submissive PE Develop
May be slow Pulmonary hypertension over years resulting from pulmonary embolism
26
What do you do with patients with low risk of a PE
Monitor and assess
27
Whose at risk for a septic embolism
Intravenous drug users
28
What causes septic embolism
Vegetation on tricuspid valve or pulmonary valve leads to vegetation entering pulmonary arteries Emboli lodges in small aw causing infection and growing abscesses, infarcts, and cavities
29
What is used to rule out low suspension PE patients
PERC Rule Wells score (Should they go home)
30
What do you do if a patient presents with high clinical suspicion
Move quickly toward definitive testing and treatment.
31
What are the risk of PE diagnostic studies
Expensive Potentially inconclusive Potentially harmful
32
What is the gold standard for PE diagnosis
CT pulmonary angiogram
33
Explain a CT angiogram
Injects a contrast into veins to make them seem opaque Can cause kidney damage Look for abrupt cut off
34
How do you test for a PE for a pregnant or pt. W/ kidney disease
Ventilation/perfusion scan
35
How does the V/Q scan work
VENTILATION: A patient inhaled a Nebulizer radioisotope w/ short half life Use nuclear medicine scan to view AW PERFUSION: Inject isotope and scan pulmonary vessels
36
Shortcoming of the V/Q scan
Many test will have indeterminate results
37
How is sonograms used to diagnose PE
Ultrasound imaging of lower extremity can detect deep vein thrombosis Cardiac ultrasound can detect right heart strain
38
39
What is the D-dimer
A protein fragment left in the blood after the clot degrades by fibrinolysis
40
How much D-dimer does not indicate PE
500ng/mL or greater
41
Secondary to PE when might a patient have D-dimer in their blood
After surgery Sensitive, but not specific
42
43
What Wells score indicates high probability of PE
> 6
44
What Wells score indicates moderate probability of PE
2-6
45
What Wells score indicates low probability of PE
< 2
46
What role does “PERC” play in the diagnosis of PE
Should a patient go home/ rule out criteria
47
What patients get the PERC test
Low risk for PE
48
What happens if a patient is flagged for a PERC test
D-dimer test is done, which can lead to imaging
49
How many yeses do you need for the PERC test for further testing
Only one yes
50
What are the managements for acute PE
Surgery Thrombolytics Anticoagulant
51
What surgery is done for patients with PE
Thrombectomy
52
Who as thrombectomys done
Hemodynamic unstable patients
53
How is a thrombectomy
A catheter is advanced through right femoral vein Either: suction, or fragmentation and suction Mortality is relatively high
54
What is a thrombolytic
Used to breakdown blood clots indiscriminately
55
What does PERT stand for
Pulmonary embolism response teams
56
Name the thrombolytic
Tissue plasminogen activator (tPA) (Applied at site)
57
What anticoagulant is given
Unfractionated heparin (IV) Hold until thrombolytics are complete
58
What are the managements for stable PE patients
Heparin and supportive care
59
What long term prophylaxis is given to stable PE patients
Low-molecular-weight heparins (Oral) Enoxaparin (lovenox) Warfarin (Coumadin) Apixaban (Eliquis)
60
What can we do for the heart of stable PE patients
Inferior Vena Cava filter (Greenfield filter) (Device can migrate, cause a thrombosis)
61
What are chronic Mgt. of PE risk
Walking Exercise while seated Drink fluids Compression socks Pneumatic compression on legs

Disease II (14 decks)

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