Pulmonary embolism Flashcards
(12 cards)
What does the virchow triad consist of
Venous stasis, endothelial injury, hypercoagulable state
What will you expect in physical examination in OE
Sudden onset SOB
Tachycardia
What variables arein Well’s prediction for PE
- DVT signs and symptoms
- Based on clinical experience
- HR >100
- Immobilization or surgery in previous 4 weeks
- Previous DVT or PE
- Hemoptysis
- Cancer
What is the first step if there is a high probability of PE
Start anticoagulant with LMWH first and arrange for CTPA
What is the next step if there is low probability of PE
May consider D-dimer test while ruling out other diagnosis through CXR etc
If patient turns hemodynamically unstable what is the next step
Do a bedside TTE to assess for RV dysfunction –> arrange for CTPA if not already done
How do you manage hemodynamically unstable patients with PE
Empiric anticoagulation (IV hep vs LMWH) AND thrombolysis if PE confirmed and not contraindicated
What are some contraindications for thrombolysis
- Recent ICH, or intracranial surgery
- Ischemic stroke within 3 months
- Aortic dissection
- Active menses
- Intracranial neoplasm
What are some other relative contraindication to consider before thrombolysis
- Severe or poorly controlled hypertension
- Prolonged CPR or surgery
- Pregnancy
- Diabetic retinopathy
- Bleeding tendency
What is the common dose for thrombolytics
Alteplase 10mg bolus then 90mg over next 2 hours
What is the meaning of intermediate risk PE
Not hemodynamically unstable but with RV strain and increased trop
How do you manage non-massive pulmonary embolism
Initiate empiric anticoagulation if PE confirmed (warfarin, rivaroxaban or LMWH). For 3 months if there is modifiable risk factor but indefinite if non-modifiable risk factor
