Pulmonary Embolism

Question 1

Pulmonary Embolism

Answer 1

Block of pulmonary artery by a blood clot, fat, tumour or air.

Question 2

How does PE cause pulmonary infarction?

Answer 2

Blood flow & oxygen supply to lung tissues is compromised => lung tissue may die.

Question 3

Cause

Answer 3

Usually arise from DVT in pelvis or legs

Question 4

How does DVT cause PE

Answer 4

Clots break off & pass through veins & right side of the heart.

Question 5

Classification ation

Answer 5

Massive (with shock or syncope), Major (with RV dysfunction), Major (with normal RV function), Minor.

Question 6

DVT Classification ficaion

Answer 6

Proximal (Ile-femoral) & distal (popliteal)

Question 7

Proximal (Ileo-Femoral)

Answer 7

Most likely to embolise & lead to chronic venous insufficiency & venous lung ulcers.

Question 8

What DVT is more likely to embolise

Answer 8

Proximal: Ileo-femoral.

Question 9

Risk Factors

Answer 9

Surgery, immobility (long-haul flight), oral contraceptive, pregnancy, pelvic obstruction, trauma, thrombophilia, malignancy, obesity, pulmonary hypertension, IV drug users, vascularise.

Question 10

Virchow ‘s Triad

Answer 10

1. Factors in vessel wall.
2. Abnormal blood flow.
3. Hypercoagulable blood.

Question 11

Side effects of anticoagulants

Answer 11

Increased risk of bleeding.

Question 12

Symptoms: General

Answer 12

Acute SOB, collapse, pleuritic, chest pain, haemoptysis, sudden death.

Question 13

Signs: General

Answer 13

Tachycardia, tachypnoea, cyanosis, fever, low BP, crackles, pleural rub, signs of pleural effusion.

Question 14

Symptoms/Signs: Large

Answer 14

CV shock, low BP, central cyanosis, sudden death, sustained systolic <90, sever hypoxaemia.

Question 15

Symptoms/Signs: Medium

Answer 15

Pleuritic pain, haemoptysis, dyspnoea

Question 16

Symptoms/Signs: Small/Recurrent

Answer 16

Progressive dyspnoea, pulmonary hypertension, right heart failure.

Question 17

Symptoms: DVT

Answer 17

Whole leg or calf swollen, red, hot and tender.

Question 18

Investigations: PE

Answer 18

CXR, ECG, D-diners, Isotope lung scan, CTPA, Perfusion (Q) scan, ABGs

Question 19

Investigations: DVT

Answer 19

ultrasound Doppler leg scan, CT scan.

Question 20

Early CXR

Answer 20

Normal

Question 21

Later CXR

Answer 21

Basal atelectasis, consolidation & pleural effusion.

Question 22

ECG

Answer 22

Acute right heart strain pattern & acute dilatation of RV.

Question 23

D-dimers

Answer 23

Usually raised

Question 24

Isotope lung scan

Answer 24

Sensitive for small peripheral embol, perfusion defect before infarction, V/Q matched defect after infarction.

Question 25

When should a Perfusion (Q) scan used

Answer 25

If pregnant

Question 26

ABGs

Answer 26

Decreased PaO2 & SaO2, type I Resp failure, Resp alkalosis

Question 27

Management of low risk

Answer 27

Ambulatory pathway -> home

Question 28

Management of high risk

Answer 28

BP Monitoring & MHDU.

Question 29

Management of intermediate high risk

Answer 29

Ward or MHDU

Question 30

Should you provide treatment before test results in low suspicion PE?

Answer 30

Wait for results.

Question 31

Should you provide treatment before test results in moderate suspicion PE?

Answer 31

Weigh pros & cons

Question 32

Should you provide treatment before test results in high suspicion PE?

Answer 32

Empirical treatment

Question 33

Treatment for DVT/PE

Answer 33

Thrombo-embolectomy, intra-catheter directed thrombolysis, EKOS.

Question 34

Treatment of Massive PE

Answer 34

Thrombolysis or surgery

Question 35

Treatment of Major PE (with RV dysfunction)

Answer 35

Anticoagulants & thrombolysis

Question 36

Major PE (Without RV dysfunction)

Answer 36

O2, thrombolysis, anticoagulants.

Question 37

Prevention of DVT

Answer 37

Early post-op mobilisation, TED compression stockings, calf muscle exercises, subcutaneous low dose mol weight heparin peri-operatives, DOAC, IVC filter to prevent embolisation from ileofemoral clot.

Question 38

Duration of Treatment for unprovoked PE

Answer 38

6 months

Question 39

Duration of Treatment for provoked PE

Answer 39

3 months

Question 40

Duration of Treatment of unprovoked low-risk PE

Answer 40

3 months

Question 41

Duration of treatment of high risk proximal DVT

Answer 41

6 months

Question 42

Duration of treatment of recurrent PE

Answer 42

Life-long.