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Flashcards in PE -Goya Deck (14):
1

Where do most PEs originate?

DVT in the lower extremities

*preventing DVT can prevent PE*

2

What are some risk factors for PE?

-immobilization--> dec venous blood flow
-50-60 yo
-women on birth control
-estrogen therapy
-pregnancy
-a fib and CHF
-trauma / burns
-cancer
-genetic/acquired thrombophilia

3

What is the only consistent finding with a PE?

tachypnea

can also get dyspnea and chest pain --> acute SOB and CP

4

What chest x-ray findings suggest PE?

Hampton’s Hump (infarcted lung) & Westermark sign (abrupt cut off of the pulm. A)

Normal CXR with severe dyspnea & hypoxemia suggest PE

5

What are some common tests used to help diagnose a PE?

-ABG: hypoxemia or a widened A-a gradient, hypocarbia in acute PEs

-D-dimer=highly sensitive but not specific --> used to r/o PE

-CT angiogram-95% sensitive in dx PE. also can detect pulmonary abnormalities ***what we normally use

-VP scan --> when pts cannot take IV contrast**

-pulmonary angiogram

6

What is the gold standard for diagnosing PE?

pulmonary angiogram

much more invasive than CTA because go in to the pulmonary A

7

What is often used for diagnosing PEs before invasive tests?

Doppler Ultrasound ==> if detect a DVT, can assume that the pt has a PE

caution in previous DVTs--> pt may not return to normal with recurrent DVT

8

A 50-year-old man is evaluated in the emergency department for 4-day history of pain, swelling and erythema of left leg. There is not history of recent surgery, trauma, recent travel or infection. On physical exam , temp is 100.0o F, blood pressure is 135/62 mmHg, Pulse rate 68/min, resp rate is 16/min. Examination of left lower leg shows tenderness on posterior portion of leg and 1 cm increase in circumference compared to right leg at 10 cm below tibial tuberosity. Ther is no evidence of varicose vein.
Which of the following is most appropriate next step in diagnosis?
A. Ventilation perfusion scan
B. Venography of left leg
C. Assay for plasma d-dimer
D. Measurement of antithrombin III.

C. Assay for plasma d-dimer

if D-dimer is -, it is NOT a PE

9

What are the absolute contraindications to anticoagulation?

Active Bleeding

Platelet count < 20,000

Neurosurgery, ocular surgery or intracranial bleeding with the past 10 days

10

What are the initial and long term therapies for thromboembolic disease?

Initial Therapy:
-Unfractionated Heparin (continuous IV infusion)
-Low Molecular Weight Heparin (LMWH) (*tx of choice in out pt DVT) (do not need to monitor PTT levels)

Long Term Therapy:
-Coumadin
-New oral anticoagulants

*normally give LMWH and coumadin together

11

What are the contraindications for giving LMWH?

Renal Failure

Obesity

Allergy to Heparin

Contraindications to the use of anticoagulation

12

What determines how long a pt with a PE should remain on oral anticoagulation?

Total duration is dependent on predisposing risk factors for DVT:

Treat for 3 months and reassess

if low risk of bleeding, continue to treat for 6 months.

if high risk for bleeding, treat for 3 months only

if coagulation problems (deficiency of antithrombin, protein C or S, factor V leiden cancer), treat indefinitely

13

When should thrombolytic treatments be given?

for PE with hypotension or high risk hypotension

activates plasminogen to lyse clot

14

What are the 2 surgical options for PE treatment and when should they be used?

embolectomy should only be used with documented massive PE who are in refractory shock

inferior vena cava interruptions are used in prophylaxis against recurrent PEs despite adequate anticoagulation or if there is contraindication to anticoagulation
-IVC filters did not improve mortality and has a lot of complications