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
