Pulmonary Embolism Flashcards
(14 cards)
What is a PE?
A life threatening respiratory condition caused by a clot in the lung arteries - usually caused by a deep vein thrombosis
Where do PE’s come from?
Deep Vein thrombosis
What puts you at risks for PE?
See table of risk factors:
https://academic.oup.com/eurheartj/article/41/4/543/5556136?login=false#211358683
Strong includes: Fractures, trauma, previous VTE
Moderate includes: contraceptive pills, severe infections, chemotherapy, heart failure
Weak includes: bed rest, obesity, pregnancy, immobility
When should you use a wells score?
To risk stratify if PE is likely
Do all wells score require you to also do a D-Dimer?
If high well score then can go direct to CTPA without D-Dimer
Note if low or moderate risk, please use age adjusted D-Dimer
What is the PESI score or sPESI score?
PE severity index/ simplified PE severity index work out severity of PE and risk of mortality
When should we admit PE’s?
Most PE’s can be managed as an OP if clinically well.
Those with a raised sPESI score may need a short admission
Those with Hypoxia will need admission till off O2
How do we risk stratify PE’s?
High risk PE - those which are in shock despite cautious fluid resuscitation or cardiac arrest caused by PE
Intermediate high risk PE - PE with RHS and raised trop/BNP
Intermediate low risk PE - PE with RHS OR raised trop/BNP
Low Risk PE - PE with no RHS or raised Trop/BNP
How do we initially treat PE’s?
Depends on clinical scenario
Options:
High risk PE - Systemic Thrombolysis with alteplase
Note: catheter directed thrombolysis/ mechanical thrombectomy can be used in specialist centres
Intermediate and Low risk PE - LMWH/DOAC/Warfarin
Is the treatment different in PE if someone has right heart strain?
It is advised to have cardiac monitoring in case of risk of deterioration.
Ensure Troponin & BNP Checked to help risk stratify
What is a “massive” PE and what’s the difference in management?
This term is outdated and we should stick to high risk, intermediate high risk, intermediate low risk, and low risk PE.
if High risk PE then need to consider systemic thrombolysis
Why does classifying PE’s as provoked or unprovoked PE’s matter?
Long term treatment is dependent on provoked or unprovoked PE
What extra examination or tests would you do for unprovoked PE’s?
Review the medical history and baseline blood test results including full blood count, renal and hepatic function, PT and APTT, and offer a physical examination.
Do not offer further investigations for cancer to people with unprovoked DVT or PE unless they have relevant clinical symptoms or signs
What follow up would you give for PE’s?
PE clinic follow up in 3 months time
If patient has right heart strain on initial scan then can request for an OP ECHO in 2 months time prior to Follow up PE clinic
