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Flashcards in Pulmonary Embolism Deck (14)
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1

What can make up a pulmonary embolus?

Thrombus
- often from DVT/groin

Fat
- bone fracture

Amniotic
- pregnancy

Air

2

Risk factors for pulmonary embolism

Pregnancy
Immobilization
Previous VTE
Contraceptive pill
Cancer
Obesity

3

Pathophysiology of pulmonary embolism

Right ventricular overload
- increase in pressure in pulmomary artery
- right ventricular dilatation and strain

Respiratory failure
- areas of V/Q mismatch
- Low right ventricle output

Pulmonary infarction
- alveolar haemorrhage

4

Symptoms of PE

Cough
Dyspnoea
Pleuritic chest pain

5

Signs of PE

Tachycardia
Tachypnoea
Pyrexia

6

Differential diagnoses of PE

Pneumothorax
Pneumonia
Pleurisy
Musculo-skeletal chest pain
MI
Pericarditis

7

Investigations for a suspected PE

Bloods
- FBC
- U&Es
- Coagulation
- troponin

ABG - hypoxaemia + hypocapnia

CXR - exclude other diagnoses

ECG - S1Q3T3

8

Classification of PE

Massive = <90 systolic BP
Submassive = RV dysfunction
Non-massive = no severe symptoms

9

What is PE Wells Score?

Objectifies risk of PE

>4 = PE likely
= = PE unlikely

10

What is PERC?

PE rule out criteria

11

Management of PE

ABCDE
O2
Analgesia
IV Heparin
tPA (streptokinase/alteplase)

12

When is thrombolysis used?

Massive/submassive PE

13

What are the X-ray changed in PE?

Mostly normal

Fleischner sign = enlarged pulmonary artery

Hampton hump = peripheral wedge of airspace opacity - lung infarction

Knuckle sign = abrupt tapering of pulmonary artery

14

What are the ECG changes in PE?

Most commonly = sinus tachy

Right heart strain
- RBBB
- right axis deviation

S1Q3T3
- lead 1 = deep s wave
- lead 3 = q + t wave inversion