Pulmonary Embolism Flashcards
(47 cards)
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
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
What proportion of VTE are PE?
- 1/3
Identify three symptoms of PE
- Dyspnoea
- Pleuritic chest pain
- Tachypnoea
- Unilateral painful leg swelling
- Dizziness or syncope
- Retrosternal chest pain
Identify three signs of PE
- Tachycardia
- Hypotennsion
- Hypoxaemia
- Raised JVP
- Pyrexia
- Gallop rhythm
- Pleural rub
What criteria is used to estimate probability of a PE?
- Two level PE Wells score
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
What Wells score indicates a likely PE?
- More than 4
Identify three other initial investigations that should be performed
- CXR
- ECG
- ABG
What is most commonly seen on CXR, what is less commonly seeen?
- Normal
LESS COMMON
- Atelectasis
- Pleural effusion
- Raised hemidiaphragm
What is most commonly seen on ECG, what is less commonly seen?
- Sinus tachycardia
LESSON COMMON
- S1Q3T3
- Right axis deviation
- RBBB
Identify two possible findings on ABG
- Respiratory alkalosis
- Type 1 respiratory failure
Identify three differential diagnoses of a PE
- Pneumothorax
- Acute exacerbation of asthma
- Acute exacerbation of COPD
ACS - Acute congestive cardiac failure
What secondary care investigation should be performed for a Wells of more than 4?
- CTPA
A CTPA cannot be performed immediately. What should be done?
- Give interim therapeutic anti-coagulation with a DOAC (apixaban or rivaroxaban)
What secondary care investigation should be performed for a Wells of 4 or less?
- D-Dimer test
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)
What should be done if the D-dimer test is positive?
- CTPA
Identify three indications for V/Q scanning in place of CTPA
- Pregnancy
- Renal impairment
- Contrast allergy
- Younger patient
Identify four baseline values that should be obtained prior to commencing oral anticoagulant therapy
- FBC
- LFT
- U&E
- Coagulation studies
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
What should be administered if SBP remains less than 90 mmHg following thrombolysis?
- Give inotropic agent such as noradrenaline or dobutamine
What should be done if all interventions fail in haemodynamically unstable PE?
- Perform pulmonary embolectomy
What is PESI?
- Pulmonary Embolism Severity Index
- Used to determine whether patient may be discharged or requires admission
