PE Flashcards
1
Q
Pulmonary emboli can be caused by
A
- Thrombosis
- Fat (long bone fracture, orthopaedic surgery)
- Amniotic fluid
- Air (following neck vein cannulation or bronchial trauma)
2
Q
Three factors causing blood clots?
A
Increased coagulability, reduced mobility, blood vessel abnormalities
3
Q
Major PE risk factors?
A
- Surgery
- Obstetric (late pregnancy, puerperium, CS)
- Lower limb problems
- Malignancy
- Reduced mobility
- Other (major trauma, spinal cord injury, central venous lines)
4
Q
Minor risk factors
A
- CV (CHD, CCF, hypertension, paralytic stroke)
- Oestrogens (pregnancy, combined oral contraceptive, HRT)
- Haematological (thrombotic disorders, myeloproliferative disorders)
- Renal (nephrotic syndrome, chronic dialysis)
- Misc (COPD, neurological disability, occult malignancy, obesity)
5
Q
Symptoms of PE
A
- Dyspnoea
- Pleuritic chest pain
- Cough and haemoptysis
- Any chest symptoms in patient with DVT
- RHF can cause dizziness
6
Q
Signs of PE
A
- Tachypnoea, tachycardia
- Hypoxia
- Pyrexia
- Raised JVP
- Gallop heart rhythm
- Pleural rub
- Systemic hypotension and cardiogenic shock
7
Q
PE Differentials
A
ACS, aortic dissection, cardiac tamponade, pneumonia, pneumothorax, sepsis
8
Q
Managing PE first steps
A
Carry out assessment of general Hx, physical examination and CXR to exclude other causes
9
Q
PE suspected and likely two-level PE Wells’ score management
A
Either
- Immediate CTPA or
- Immediate interim parenteral anticoagulant therapy followed by CTPA
10
Q
PE suspected and unlikely two level PE Wells’ score management
A
D-dimer test, if positive manage as PE
11
Q
If CTPA contraindicated?
A
V/Q SPECT
12
Q
What further tests should be offered after PE management
A
- Exclude malignancy: physical examination, CXR, bloods, urinalysis
- Consider further Ix for cancer with abdominal CT for first unprovoked PE and over 40
13
Q
Wells score features
A
- Clinically suspected DVT 3
- Alternative diagnosis less likely 3
- Tachycardia 1.5
- Immobilisation 1.5
- Hx of DVT or PE 1.5
- Haemoptysis 1.5
- Malignancy 1.5
If over 4, PE likely
14
Q
Management of PE
Initial resuscitation
A
- Oxygen
- IV access, baseline Ix
- Analgesia
- Assess circulation (massive PE if systolic below 90, or if fall of 40 for 15 minutes)
15
Q
PE Ix
A
- Baseline
- ECG (sats, FBC, clotting, biochem, troponin and brain natriuretic peptide may be raised)
- CXR
- ABG
- Echo
- Cardiac troponins (right heart strain)
- D-dimers
- Leg ultrasound
