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RM - Resp Conditions Profiles > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

(53 cards)

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1
Q

What is the primary cause of pulmonary embolisms?

A

Thrombus from systemic veins

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2
Q

Where do <10% of the thrombi for pulmonary embolisms come from?

A

Right heart

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3
Q

What is the origin of the majority of thrombi that cause PEs?

A

DVTs from the pelvis or legs

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4
Q

What are the 3 components of Virchow’s Triad?

A

Hypercoaguable state
Endothelial injury
Circulatory status

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5
Q

What are the 4 other causes of PEs (other than a thrombus)

A

Fat
Tumour
Amniotic fluid
Foreign material

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6
Q

What is the common cause of a fat emboli?

A

Long bone fractures

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7
Q

What are the 2 types of risk factors for a PE?

A

Exposing and predisposing risk factors

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8
Q

What are exposing risk factors for PEs?

A

Acute conditions or trauma/surgery

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9
Q

Describe predisposing risk factors for PEs

A

Patient medical conditions that generally inhibits normal circulation

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10
Q

What are 5 examples of predisposing risk factors?

A 
Age
Obesity
CHF
Immobility
Pregnancy
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11
Q

What are the 4 key risk factors for a PE?

A

Surgery
Malignancy
Pregnancy
Clotting Abnormality

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12
Q

When does the contraceptive pill become a greater PE risk factor?

A

When it combined with smoking

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13
Q

What does a PE mean in terms of ventilation and perfusion of the lung tissue?

A

The tissue is ventilated but not perfused

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14
Q

After a few hours of lung tissue not being perfused, the production of ____ stops

A

Surfactant

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15
Q

What is the consequence of surfactant not being produced in infarcted lung tissue? (2)

A

Alveolar collapse and therefore worsening of hypoxia

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16
Q

Why does a PE cause an decrease in cardiac output?

A

There is a reduced pulmonary blood flow and an elevated pulonary arterial pressure

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17
Q

What does the clincal presentation of a PE depend on?

A

The size of the embolism

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18
Q

What are the 4 clincial presentations of a Massive PE?

A

CV shock
Low BP
Central cyanosis
Sudden death

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19
Q

What are the 3 symptoms of a medium PE?

A

Pleuritic pain
Haemotysis
Breathlessness

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20
Q

What are the 3 symptoms of small, recurrent PEs?

A

Progressive dysponea
Pulmonary hypertension
Right cardiac failure

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21
Q

What are the 2 clinical findings of a PE?

A 
Pleural rub (Localised)
Coarse crackles
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22
Q

What kind of resp failure are PE patients normally in?

Study These Flashcards
A

Type one

Low PaO2 and SaO2

23
Q

What is the normal CXR finding of a PE?

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A

Normal (especially early on)

24
Q

What are the 3 possible CXR signs of a PE?

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A

Basal atectasis (collapse)
Consolidation
Slight pleural effusion

25
What is an indicative, but very rare sign of a PE on a CXR?
Wedge shaped infarct
26
What is the classic ECG presentaiton of a PE?
S1 T3 Q3 - Rare to see this | S wave in I, inverted T wave in III and Q waves in III
27
What are the 3 more common ECG signs of a PE?
Tall P wave in II RBBB T wave inversion (on right pre-cordial leads)
28
What test is used to rule out a PE?
D-dimer | If negative, not PE
29
What kind of imaging can be used to detect small, peripheral emboli?
Isotope lung scan (V/Q scan)
30
What is the more accurate, and commonly used imaging in PE diagnosis?
CTA (CT pulmonary arteries)
31
What is able to detect pulmonary artery filling defects?
CTA
32
What imaging can best identify larger clots causing PEs?
CTA
33
What is a test that can be done to determine the cause of a PE?
Ultrasound of the legs and pelvis - look for a DVT
34
What feature on an ECG is inkeeping with a PE?
RV dilation
35
Initially, what needs to be clarified/determined in the treatment of PEs?
Whether it is high risk or 'non-high' risk
36
What 2 things must be present for a PE to be classed as high risk?
Shock or hypotension
37
If a PE is deemed high risk, what is the imaging used to confirm the diagnosis?
CTA
38
What needs to be done to determine the treatment of non-high risk PEs?
Well's score - determines the probability of a PE
39
What Well's score is needed to make a PE likely?
= 4
40
What are the 7 components of the Well's scoring system?
``` Clinical signs of DVT PE most likely DDx HR >100 Immobilisation for 3 days/surgery within 4 weeks PMHx of DVT or PE Haemotpysis Malignancy within 6 months ```
41
If the Well's score deems a PE likely, what is the next course of action?
CTA to confirm diagnosis
42
If the Well's score deems a PE unlikely, what should be done?
A D-dimer
43
What are the 3 main components of the acute management of a PE?
``` High flow O2 (everyone except those with significant chronic resp disease) IV fluids (improve right heart pumping) Anticoagulation ```
44
What are the 2 aims of the anti-coagulation in PE treatment?
Stop clot propagation | Tip body into thrombolysis state - able to break down clot itself
45
What is the normal anti-coagulation therapy given in PE treatment?
Subcutaneous low molecular weight heparin
46
What 2 things can be given instead of anti-coagulation?
Oral thrombin inhibitor (Dabigatran) Or Factor X inhibitor (Rivaroxaban)
47
How long does it take for warfarin to antagonise the Vit K dependant prothrombin? (I.e. for it to make an effect)
3 days
48
When should the heparin be stopped post PE? (2)
3-5 days | INR>2
49
When should warfarin be started in PE treatment?
At the same time as heparin
50
What is the long-term treatment for a PE patient (duration)?
Warfarin | 3-6 months
51
What is the special/extra treatment given to those with life-threatening PEs?
Thrombolysis with tissue plasminogen activator (tPA) - i.e. tenecteplase
52
What device can be fitted to stop PEs from happening again?
IVC filter
53
What are the 4 key components to PE prevention?
Early post-op mobilisation Compression stockings Calf-muscle exercises Subcutaneous, low dose LMWH perioperatively

RM - Resp Conditions Profiles (8 decks)

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