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Flashcards in Pulmonary Embolism Deck (47)
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1

Identify three embolic sources

- Thrombus from venous system

- Tumour from prostate or breast cancer

- Fat from long-bone fracture

- Amniotic fluid from pregnancy

- Sepsis from IVDU

2

Identify five risk factors for a PE

- DVT

- Previous VTE

- Active cancer

- Recent surgery

- Recent immobilisation

- Lower limb trauma or fracture

- Pregnancy and 6 weeks postpartum

- Increasing age

- Oral contraceptive use

- HRT

- Obesity

- Comorbidities

- Varicose veins

- Thrombophilia

3

What proportion of VTE are PE?

- 1/3

4

Identify three symptoms of PE

- Dyspnoea

- Pleuritic chest pain

- Tachypnoea

- Unilateral painful leg swelling

- Dizziness or syncope

- Retrosternal chest pain

5

Identify three signs of PE

- Tachycardia

- Hypotennsion

- Hypoxaemia

- Raised JVP

- Pyrexia

- Gallop rhythm

- Pleural rub

6

What criteria is used to estimate probability of a PE?

- Two level PE Wells score

7

Identify three criteria on PE wells score

- Clinical features of DVT

- Alternative diagnosis is less likely than a PE

- Heart rate greater than 100

- Immobilisation for more than 3 days or surgery in previous four weeks

- Haemoptysis

- Malignancy

8

What Wells score indicates a likely PE?

- More than 4

9

Identify three other initial investigations that should be performed

- CXR

- ECG

- ABG

10

What is most commonly seen on CXR, what is less commonly seeen?

- Normal

LESS COMMON

- Atelectasis

- Pleural effusion

- Raised hemidiaphragm

11

What is most commonly seen on ECG, what is less commonly seen?

- Sinus tachycardia

LESSON COMMON

- S1Q3T3

- Right axis deviation

- RBBB

12

Identify two possible findings on ABG

- Respiratory alkalosis

- Type 1 respiratory failure

13

Identify three differential diagnoses of a PE

- Pneumothorax

- Acute exacerbation of asthma

- Acute exacerbation of COPD
ACS

- Acute congestive cardiac failure

14

What secondary care investigation should be performed for a Wells of more than 4?

- CTPA

15

A CTPA cannot be performed immediately. What should be done?

- Give interim therapeutic anti-coagulation with a DOAC (apixaban or rivaroxaban)

16

What secondary care investigation should be performed for a Wells of 4 or less?

- D-Dimer test

17

A D-dimer test cannot be performed within 4 hours. What should be done?

- Give interim therapeutic anti-coagulation with a DOAC (apixaban or rivaroxaban)

18

What should be done if the D-dimer test is positive?

- CTPA

19

Identify three indications for V/Q scanning in place of CTPA

- Pregnancy

- Renal impairment

- Contrast allergy

- Younger patient

20

Identify four baseline values that should be obtained prior to commencing oral anticoagulant therapy

- FBC

- LFT

- U&E

- Coagulation studies

21

Outline the management of a haemodynamically unstable patient

- IV fluids over 15 minutes

- Oxygen therapy

- UFH prior to thrombolysis (stopped within 24 hours)

- Thrombolysis with alteplase

22

What should be administered if SBP remains less than 90 mmHg following thrombolysis?

- Give inotropic agent such as noradrenaline or dobutamine

23

What should be done if all interventions fail in haemodynamically unstable PE?

- Perform pulmonary embolectomy

24

What is PESI?

- Pulmonary Embolism Severity Index

- Used to determine whether patient may be discharged or requires admission

25

Identify three conditions in which PESI should not be used

- Hypotensive

- Pregnancy

- Active cancer

26

Identify two factors that the PESI takes into account

- Right ventricular dysfunction

- Cardiac biomarkers.

27

What PESI score requires admission but not close monitoring?

- 3 or 4

28

What PESI score indicated outpatient management?

- 1 or 2

29

Outline the management of a PE in a patient who is haemodynamically stable who has no co-morbidities

- DOAC for 3 months

- Stop after 3 months if provoked

30

Outline the management of a PE in a patient who is haemodynamically stable who has active cancer

- DOAC for 6 months

- Stop after 6 months if provoked