Pulmonary embolism

Question 1

What’s first line for PE?

Answer 1

stabilize = O2, intubate, ventilation/IV fluids/vasopressors for HOTN

Question 2

How do you decide inpatient or outpatient for a PE patient?

Answer 2

pulmonary embolism severity index

Question 3

What should you start immediately for a PE patient?

Answer 3

anticoag - heparin immediately, + transition to warfarin, lovenox, or DOAC (first line transitioning) for a minimum of 3 months

Question 4

When are indefinite anticoagulants not considered in PE?

Answer 4

in PROVOKED (caused) episodes w/ – the transient risk factor no longer present, isolated distal DVT, subsegmental or incidental PE, risk of bleeding high. Cancer related.

Question 5

When are anticoags indicated INDEFINITELY for PE?

Answer 5

UNPROVOKED proximal DVT, unprovoked symptomatic PE, active cancer, antiphospholipid antibodies/syndrome, recurrent episode, low risk of bleeding

Question 6

If anticoagulation is CI or bleeding risk is high in PE pt, what should be placed?

Answer 6

IVC filter – preferred to remove when resolved @ 1 year

Question 7

For severe PE, what’s the treatment?

Answer 7

catheter-directed embolectomy/thrombolysis,, surgical thrombolysis

Question 8

When is thrombolysis not possible for PE patients?

Answer 8

active bleeding, stroke w/n 3 months

probably not in: uncontrolled HTN, surgery or trauma w/n past 4 weeks

Question 9

If a thrombolysis is not possible for a severe PE, what do you do?

Answer 9

embolectomy