Pulmonary Embolism

Question 1

What is the Wells Score?

Answer 1

Used to decide investigations for suspected PE
‘1 Direction Thinks I Have Hidden Motives’
1- No.1 diagnosis is PE (3 points)
D- DVT clinical signs (3)
T- Tachycardia (1.5)
I - Immobilisation (1.5)
H - History of PE/DVT (1.5)
H- Haemoptysis (1)
M - Malignancy (1)

> 4 points = order CTPA
4 points or less = d-dimer
If d-dimer +ve -> CTPA
If d-dimer -ve -> stop anticoagulation and consider alternative diagnoses

Question 2

Management of a pulmonary embolism?

Answer 2

If PE suspected -> LMWH/ DOAC, stop if PE ruled out

When PE confirmed -> continue on a DOAC or LMWH/warfarin if DOAC is contraindicated

If massive PE -> IV alteplase. If thrombolysis contraindicated offer Embolectomy, or Catheter derived thrombolysis (use CDT if high bleeding risk)

THEN…

If provoked PE -> continue anticoagulation for 3 months or 3-6 months if also active cancer

Unprovoked PE -> continue anticoagulation for minimum 3 months

Question 3

What defines a massive PE?

Answer 3

A PE causing hypotension for over 15 minutes