Pulmonary embolism Flashcards
What is a PE? What is it most commonly caused by?
occlusion of pulmonary vessels
Thrombus that has travelled from another site
List 3 causes of PE other than thrombi
Fat
Amniotic fluid
Air
List 7 risk factors for PE
Surgical patients Immobility Obesity OCP Heart failure Malignancy Previous DVT/ PE
Describe the epidemiology of PE
Relatively common
What are 3 broad causes of PE
Hypercoagulability (e.g. increased platelet adhesion, thrombophilia). Venous stasis (e.g., varicosis, immobilization) Endothelial damage (e.g., inflammation, trauma)
List 4 symptoms of PE
Sudden onset SOB
Pleuritic/ retrosternal chest pain
Cough
Haemoptysis.
List 6 signs of PE
Tachypnoea Tachycardia. Hypoxia Pyrexia. Elevated JVP Systemic hypotension + cardiogenic shock.
What can be heard on auscultation in PE?
Gallop heart rhythm
Widely split 2nd heart sound
Tricuspid regurgitant murmur.
Pleural rub
What is performed to determine next steps in suspected PE?
Well’s Score
Low Probability ,<4: use D-dimer
High Probability > 4: required imaging (CTPA)
Which bloods would you perform?
ABG: reduced PaO2, reduced PaCO2 due to hyperventilation
Thrombophilia screen
What may you see on an ECG in PE?
May be normal
May show tachycardia, RAD or RBBB
May show S1Q3T3 pattern
What is the preferred first investigation used for PE?
CT Pulmonary angiogram
Poor sensitivity for small emboli
VERY sensitive for medium to large emboli
What is involved in the initial resuscitation in PE?
O2 100%.
IV access, monitor closely, start baseline investigations.
Analgesia
Assess circulation: suspect massive PE if SBP <90 mmHg or a fall of 40 mmHg, for 15 mins.
What primary prevention measures can be taken for PE?
Compression stockings
Heparin prophylaxis for those at risk
Good mobilisation + adequate hydration
How are haemodynamically stable PE patients managed?
O2 Anticoagulation with LMWH 5 days Switch over to oral warfarin/ DOAC for at least 3 months Maintain INR 2-3 Analgesia
