Flashcards in Pulmonary Embolism Deck (16):
Where do most PEs arise from. (2)
Usually arise from a venous thrombosis in the pelvis or legs.
What is a PE. (2)
A clot that breaks off from another part of the body (eg legs).
It passes through the right side of the heart before lodging in the pulmonary circulation.
What are some rare causes of PE. (7)
Right ventricular thrombus (post-MI).
Septic emboli (right sided endocarditis).
Amniotic fluid embolism.
What are the risk factors for PEs. (8
Recent surgery (especially abdominal, pelvic or hip/knee replacement).
Thrombophilia(eg antiphospholipid syndrome).
Prolongued bed rest/reduced mobility.
What are the symptoms of PEs. (5)
Pleuritic chest pain.
What should you ask when taking a history of a patient with a PE. (3)
FH of thromboembolism.
What are the clinical signs of PEs. (13)
R ventricular heave.
Signs of cause (eg DVT).
What tests should be done in a patient suspected of a PE. (6
FBC, UandE baseline, clotting screen, D-dimer.
ABG may show low O2 and low CO2.
What may be seen on the CXR of a patient with a PE. (7)
May be normal.
May show oligaemia of affected segment.
Dilated pulmonary artery.
Small pleural effusion.
What is the treatment for PE. (3)
Anticoagulate with LMWH. Start warfarin. Stop heparin when INR >2 and continue warfarin therapy for a minimum of 3 months (aim for INR 2-3).
Thrombolysis for a massive PE.
Consider placement of a vena caval filter in patients who develop emboli despite adequate anticoagulation.
How can you prevent PEs. (5)
Give heparin to all immobile patients.
Prescribe compression stockings.
Encourage early mobilization.
Stop HRT and the Pill pre op.
If FH or PMH of thromboembolism, consider investigations for thrombophilia.
Who should you perform D dimers in.
Only in patients without a high probability of PE.
A negative D dimer excludes PE, a positive test does not confirm PE and imaging is required.
What is the first line imaging for a suspected PE.
A patient suddenly collapses a week after abdominal surgery.
Always suspect PE in a patient who suddenly collapses 1-2weeks after surgery.
What is the mortality rate for PE in England.