Pulmonary Embolism Flashcards
(20 cards)
What is pulmonary embolism?
A blood clot (thrombus) in the pulmonary arteries
An embolus is a thrombus that has travelled in the blood, often from a DVT in a leg.
What do DVT and PE collectively refer to?
Venous thromboembolism (VTE)
DVT stands for deep vein thrombosis.
What is prophylactic treatment aimed at reducing?
Risk of VTE
This is often used in patients with risk factors, such as before surgery.
List some risk factors for VTE.
- Immobility
- Recent surgery
- Long-haul travel
- Pregnancy
- Hormone therapy with oestrogen
- Malignancy
- Polycythaemia
- Systemic lupus erythematous
- Thrombophilia
What is a common prophylactic anticoagulant used for VTE?
Low molecular weight heparin (e.g. enoxaparin)
CI refers to contraindications such as active bleeding.
What are anti-embolic compression stockings used for?
To prevent VTE
CI includes peripheral arterial disease.
What are some clinical features of pulmonary embolism?
- Dyspnoea
- Cough
- Haemoptysis
- Pleuritic chest pain
- Hypoxia
- Tachycardia
- Raised respiratory rate
- Low-grade fever
- Haemodynamic instability causing hypotension
Can pulmonary embolism be asymptomatic?
True
It may have subtle signs/symptoms or present with sudden death.
What does ABG show in cases of pulmonary embolism?
Respiratory alkalosis
Hypoxia causes raised respiratory rate, leading to low CO2 levels.
What is the PERC rule used for?
Pulmonary embolism rule-out criteria
If clinician estimates <15% probability of PE and all criteria are met, no further investigations are required.
What does the Wells score predict?
Probability of a patient having a PE
It accounts for risk factors and clinical findings.
What is the first-line imaging test if PE is likely?
CT pulmonary angiogram (CTPA) or V/Q scan
CTPA highlights pulmonary arteries and demonstrates blood clots.
What does D-dimer help to exclude?
VTE when there is low suspicion
D-dimer is sensitive but not specific.
What is a common supportive management for PE?
- Admission to hospital
- Oxygen as required
- Analgesia as required
- Monitor for deterioration
What is the mainstay treatment for acute management of PE?
Anticoagulation
Treatment-dose apixaban or rivaroxaban is first-line.
What is used for massive PE with haemodynamic compromise?
Continuous infusion unfractionated heparin and consider thrombolysis
Thrombolytic agents include streptokinase and alteplase.
What are options for long-term anticoagulation?
- DOAC
- Warfarin
- LMWH
What is the target INR for warfarin when treating VTE?
2-3
Warfarin is first-line if antiphospholipid syndrome is present.
When should anticoagulation be continued for 3 months?
Reversible cause of PE
Beyond 3 months for unprovoked PE or recurrent VTE.
Fill in the blank: Patients with antiphospholipid syndrome should be treated with _______.
Warfarin
