Pulmonary embolism Flashcards Preview

Internal Medicine > Pulmonary embolism > Flashcards

Flashcards in Pulmonary embolism Deck (5)
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1

Risk factors

1. Recent surgery
2. Post partum, pregnancy
3. History of VTE
4. Malignancy
5. Prolonged bed rest
6. Leg fracture
7. Thrombophilia
8. Pill, HRT
9. Obesity, cigarette smoking
10. Sepsis
11. IBD

2

Clinical features

1. Sudden onset dyspnea
2. Chest pain
3. TachyP
4. Cough
5. TachyC
6. Hemoptysis

3

Possible examination findings CV

1. Elevated JVP
2. Sternal heave
3. +S2 pulmonary

4

Investigations

1. FBC, UEC, coagulation as baseline
2. ABG->hypoxemia, hypocapnia
3. ECG->sinus tachyC, RBBB. RV strain, S1Q3T3
4. CXR-> band atelectasis, elevation of hemidiaphragm, prominent central pulmonary artery
5. D-Dimer
6. +Wells score
7. VQ scan->normal reading is the best imaging to exclude PE. High reading with high clinical probability= PPV 96%
8. CTPA->imaging of choice in those with high probability of PE: direct visualisation of thrombus in central pulmonary vein
9. Consider thrombophilia screen

5

Management

1. ABC
2. Oxygen
3. IV access. Bloods: FBC, coags, UEC. Do ABG. Do ECG, CXR. Arrange CTPA if high risk or VQ scan->confirm diagnosis
4. Morphine + antiemetic
5. If massive consider alteplase (sustained hypotension, heart failure, severe hypoxemia)or IVC filter
6. Heparin infusion->adjust according to APTT, monitor PLT count
7. If BP rapid colloid infusion 500ml
8. Start warfarin regime