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Flashcards in Pulmonary Embolism Deck (15)
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1
Q

What is the gold standard to diagnose a PE?

A

Pulmonary Angiography

Obtained via percutaneous catheterization (via Femoral vein)

2
Q

What is the preferred initial diagnostic study for a PE, even though it is not the Gold Standard?

A

Helical CT Scan

3
Q

What S/Sx might present clinically with a PT suspected of PE?

A
Dyspnea
PLEURITIC CHEST PX
Hemoptysis
Inc HR, Inc RR
Orthopnea
Calf Swelling/Px
Rales/Wheezing
4th Heart sound
FACTOR V LEIDEN DEFICIENCY
4
Q

Doppler U/S is sensitive for what kinds of PEs?

A

PE’s above the knee

5
Q

A massive PE is marked by what clinical criteria?

A

Systolic BP <90mmHg
Drop in Systolic BP of >40mmHg
JVD or HYPOtension

6
Q

What clinical studies or labs might you order to determine if your PT has a PE?

A

D-Dimer to r/o PE
ABG (Marked by RESP ALKALOSIS and HYPOXEMIA)
CBC
CMP (lytes for hyponatremia) eGFR to see if contrast will be okay for CT
Troponin and BNP to r/o CHF or MI

7
Q

Which PE’s are the most fatal?

A

Axillary or subclavian in origin (can also be pelvic)

Thrombi which form around a catheter

8
Q

What two DAOAC’s can be utilized as a monotherapy?

What is a contraindication to DAOACs for PE Tx?

A

Rivaroxaban (Xarelto)
Apixaban (Eliquis)

IF PT IS HEMODYNAMICALLY UNSTABLE; DAOACs ARE NOT RECOMMENDED; use FIBRINOLYTIC AGENTS (urokinase or tPa(alteplase))

9
Q

What anticoagulant therapy is CI in pregnancy?

A

Warfarin (Coumadin)

10
Q

If you are going to Rx a PT Warfarin(Coumadin) what must you consider…

A

Bridging gap with LMWH for 4 to 5 days

11
Q

Fibrinolytics may be indicated in what case?

What are two examples?

A

Massive PE or cor pulmonale
HEMODYNAMIC INSTABILITY

Urokinase
tPa (Tissue Plasminogen Activator) Alteplase

12
Q

If anticoagulative therapies are CI what therapy would you Rx a PT either at extreme risk or with a PE?

A

Vena cava filter

13
Q

What is the therapeutic PTT desired for LMWH (Lovenox)?

A

1.5 to 2x control w/in 24hrs

Monitor platelets (do not want thrombocytopenia)

14
Q

What imaging studies would you order for a PT with a suspected DVT?

A

Contrast venography: GOLD STANDARD

Doppler U/S: (False + w/ CHF, ascites, and prior DVT) Misses calf vein DVTs

15
Q

PTs who survive an acute PE are at greater risk for what 3 key clinical conditions?

A

Recurrent PE
Pulmonary HTN
Cor Pulmonale (70% of PTs)