PEs Flashcards
(19 cards)
Risk factors for PE
Known DVT HRT/OCP Pregnancy Malignancy Immobility Hx of DVT/PE Thrombophilia
Treatment of PE?
And: if renal impairment?
Follow up?
LMWH or fondaparinux, for at least 5 d or until INR >2 for at least 24hr
Split dose if renal impairment (may montior factor 10a levels) or increased risk of bleeding
Thrombolysis: alteplase or reteplase
Other drugs: rivaroxaban (fXa inhibitor), ? embolectomy
Bring back within a week and initiate on warfarin
What is the Well’s score cut off (for immediate CTPA or anticoagulation therapy then CTPA)?
Geneva score = alternative, used in USA - less subjective but takes longer.
4 - if below this do a d-dimer first.
Clinical signs and symptoms of DVT = +3,
PE being more likely than an alternative diagnosis = +3
What are the 3 types of pulmonary fibrosis?
replacement fibrosis (after damage eg. infarction, Tb, pneumonia)
focal fibrosis - coal dust, silica
diffuse parenchymal lung disease - in fibrosing alveolitis (IPF) and EAA.
Which cells are damaged in IPF?
alveolar epithelial cells _> fibroblasts enter the alveoli -> excess accumulation of ECM -> scarring, thickening, wall fibrosis.
Drugs for IPF?
Conservative: Oxygen, pulmonary rehab
Opiates
Cyclophosphamide
Pirfenidone - not a lot of evidence
Anti-coagulation = important, esp. if travelling
Some types can respond to steroids
Drugs to avoid in IPF
Co-trimoxazole Mycophenelate mofetil Bosentan Azathioprine Prednisolone Sildenafil Warfarin Ambrisentan
Main parts of best supportive care in all IPF?
information and support (see recommendation 1.3.1) symptom relief
management of comorbidities
withdrawal of ineffective therapies
end of life care
If the person (pt. with IPF) is breathless on exertion consider:
assessment for ambulatory oxygen therapy and long-term oxygen therapy
and/or
assessment for pulmonary rehabilitation.
If the person (pt. with IPF) is breathless at rest consider:
assessment for ambulatory oxygen therapy and long-term oxygen therapy and/or
benzodiazepines and/or
opioids.
If they have a cough what other causes are possible?
gastro-oesophageal reflux disease,
post-nasal drip
Disease modifying treatment in IPF?
Advise the person with idiopathic pulmonary fibrosis that oral N- acetylcysteine4 is used for managing idiopathic pulmonary fibrosis, but its benefits are uncertain.
Characteristic chest pain in a PE?
Pleuritic
Offer antihypertensive drug treatment to people aged under 80 years with stage 1 hypertension who have one or more of the following:
- target organ damage − established cardiovascular disease − renal disease − diabetes − a 10-year cardiovascular risk equivalent to 20% or greater.
Offer antihypertensive drug treatment to people of any age with stage … hypertension.
2
If the clinic blood pressure is 140/90 mmHg or higher, what should you do?
Offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension.
When using home blood pressure monitoring (HBPM) to confirm a diagnosis of hypertension, ensure that:
for each blood pressure recording, two consecutive measurements are taken, at least 1 min apart and with the person seated
Causes of upper zone fibrosis (and mnemonic)
Berylliosis Radiation Ext. allergic alveolitis ank spond Sarcoid (middle zone) TB
Causes of lower zone fibrosis
SLE/RA
UIP - usual int. pneumonia
NSIP - nonspecific int. pneumonia
Drugs -
MTX, Amiodarone, Nitrofurantoin, Bleomycin
