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Respiratory System > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

(43 cards)

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1
Q

What are the types of embolism?

A

Thrombus
Fat
Air
Amniotic fluid
Foreign material

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2
Q

What is a venous thromboembolism?

A

Embolism caused by thrombus formed in the venous system e.g. DVT

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3
Q

What will happen to thrombi from a systemic vein?

A
  • travels though the right side of the heart
  • impacts the lungs
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4
Q

What is part of virchow’s triad?

A
  • haemodynamic changes: stasis/turbulence
  • hypercoagulability
  • vessel wall damage
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5
Q

What is the highest risk factor of pulmonary embolism?

A

Increasing age

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6
Q

Risk factors for PE

A
  • increasing age
  • surgery
  • prolonged immobility
  • previous proven VTE
  • long haul flight
  • abdominal/pelvic surgery
  • pregnancy
  • obesity
  • smoking
  • malignancy
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7
Q

What can cause vessel wall damage?

A
  • vascular access
  • injury/trauma
  • varicose veins
  • increasing age
  • surgery
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8
Q

What are causes for haemodynamic changes?

A
  • prolonged immobility
  • pregnancy
  • obesity
  • varicose veins
  • increasing age
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9
Q

What are causes for hypercoagulability?

A
  • thrombophilia - high platelets
  • oestrogen containing meds
  • cancer
  • smoking
  • pregnancy
  • obesity
  • increased age
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10
Q

What are the three main impacts of pulmonary embolisms?

A

Acute right heart strain
Respiratory failure
Pulmonary infarction

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11
Q

How do pulmonary embolism cause acute right sided heart failure?

A
  • increased pressure in pulmonary artery
  • causes RV dilatation > acute right sided heart failure
  • inotropes released to maintain systemic BP
  • causes vasoconstriction of pulmonary artery
  • increases pressure even more
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12
Q

Symptoms of a pulmonary embolism

A
  • dyspnoea
  • pleuritic chest pain
  • cough
  • syncope
  • haemoptysis
  • unilateral leg pain/swelling (DVT)
  • diaphoresis
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13
Q

Signs of pulmonary embolism

A
  • dyspnoea
  • tachycardia
  • Tachypnoea
  • low BP
  • raised JVP
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14
Q

How can pulmonary embolisms cause pulmonary infarction?

A
  • small emboli cause alveolar haemorrhage + infarction of lung tissue
  • causes haemoptysis, pleuritis + small pleural effusion
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15
Q

How do pulmonary infarction appear on a CXR?

A

Wedge or Hampton hump

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16
Q

What are the classic findings on an ECG of a patient with pulmonary embolism?

A

sinus tachycardia
SI QIII TIII
- Deep S wave in lead I
- Pathological Q wave in lead III
- Inverted T wave in lead III

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17
Q

Investigations of PE

A
  • ABG: shows respiratory alkalosis
  • chest X ray: exclude differentials
  • ECG: sinus tachycardia SI QIII TIII
  • D dimers
  • Wells score
  • CT pulmonary angiogram
  • V/Q scan
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18
Q

Diagnosis of PE

Study These Flashcards
A
  • CT pulmonary angiogram - gold standard
  • V/Q single photon emission CT scan
  • plantar VQ scan
19
Q

A PE can be ruled out if patient is D dimer … and … risk

Study These Flashcards
A

A PE can be ruled out if patient is D dimer negative and low risk

20
Q

When is a D dimer test useful for PE?

Study These Flashcards
A

Only when a patient is at a low risk of PE
(Negative test = rules out PE)
Well’s score <4

21
Q

How do we decided if a patient is at high or low risk of a pulmonary embolism?

Study These Flashcards
A

Well’s score

22
Q

What is the normal level for D dimer?

23
Q

What can cause raised D-dimer?

Study These Flashcards
A
  • PE
  • pneumonia
  • malignancy
  • heart failure
  • pregnancy
  • surgery
24
Q

What is the first line drug treatment of a PE?

Study These Flashcards
A

DOAC
e.g. apixaban

25
Treatment of pulmonary embolisms
- O2 if hypoxic - analgesia if pain - DOAC whilst awaiting CTPA - fully anticoagulated once confirmed diagnosis
26
Thrombolysis contraindications
_absolute_: - stroke <6 months ago - CNS neoplasia - GI bleed <1 month ago - recent trauma or surgery - aortic dissection . _relative_: - DOAC/warfarin - pregnancy - advanced liver disease - infective endocarditistiis
27
Further treatment of pulmonary embolism in severe cases (massive PE)
Haemodynamic support Respiratory support Surgical intervention
28
When patients are discharged after a PE they are normally switched to a oral anticoagulant, how long do they need this for?
- 3 months if identifiable temporary risk factor - indefinitely if no identifiable risk factor
29
VTE prophylaxis
- **LMWH** *e.g. enoxaparin* given to high risk patients - *warfarin* or *DOAC* if contraindicated
30
Prevention of pulmonary embolisms
- anticoagulants - mobilisation - TED stockings/AES - intermittent pneumatic compression - fall prevention - avoid unnecessary invasive procedures
31
How can pulmonary embolisms cause respiratory failure?
- low RV output - reduced perfusion to lungs - V/Q mismatch - low pO2
32
How does heparin induced thrombocytopenia occur?
- antibodies form against heparin - bind to heparin platelet complexes - platelets become activated + clump together - thrombi form - thrombi spread through body - risk of causing stroke, MI + limb ischameia
33
Main differential diagnosis for PE
- pneumothorax - pneumonia - MSK chest pain - MI
34
Why is distended neck veins (raised JVP) a sign of PE?
Increased pulmonary artery pressure More difficult for RV to empty IJV drains into subclavian vein > superior vena cava > right side of the heart
35
What should be considered in an unprovoked PE?
Underlying malignancy or thrombophilia
36
What is massive haemoptysis defined as?
>240mls in 24 hours OR >100mls/day over consecutive days
37
Management of massive haemoptysis
- lie patient on side of suspected lesion - oral *tanexamic acid* for 5 days - stop NSAIDs, aspirin, anticoagulants - consider vitamin K - CT aortogram - antibitoics if suspected RTI
38
What is a massive PE?
A PE that causes haemodynamic instability *e.g. hypotension, shock, RV dysfunction on imaging*
39
Treatment of massive PE
Thrombolysis with IV *alteplase* Surgical or catheter directed thrombectomy
40
What does Well’s score suggest?
>4 points - PE likely 4 or less points - PE unlikely
41
What should you do if Wells score suggests a PE if likely?
- immediate CTPA - if delay in CTPA, start DAOC - if positive > PE diagnosed - if negative > proximal leg vein USS if suspected DVT
42
What should you do if Wells score suggests PE is unlikely
- D-dimer test - if positive > CTPA + DOAC - if negative - stop anticoagulation + consider alternative diagnosis
43
When would a V/Q scan be used over CTPA?
- renal impairment - if contrast is a problem - easier if out of hour

Respiratory System (25 decks)

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