Pulmonary Embolism (PE) Flashcards Preview

(Finals) Respiratory medicine > Pulmonary Embolism (PE) > Flashcards

Flashcards in Pulmonary Embolism (PE) Deck (11)
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1
Q

Where do PE come from?

A

Anywhere in venous system
90% systemic veins
10% R.Heart

Majority are Abdominal in origin.
DVT also common
Axillary not uncommon

2
Q

Rare emboli materials (not VTE)

A

Fat
Tumour
Foreign Body
Amniotic Fluid

3
Q

Virchow’s Triad of thrombus formation

A

Hypercoagubility
Endothelial Injury
Disturbed Blood flow

4
Q

Risk Factors PE

A
Reduced mobility: post surgery / comorbidity / long haul travel / Functional
Active Ca
Ca treatment
>60yrs Age
Dehydration
Thrombophillias
Obesity
FH
HRT/Oestrogen usage
Long Bone fractures
IV drug usage
Pregnancy
DVT
Varicose vein Phlebitis
5
Q

Pathophysiology PE

A

lung tissue distal to embolus is ventilated but not perfused
Increase in dead space and decrease in Gas exchange
Ventilation/ perfusion mismatch
Lung tissue denatures shortly (and eventually necroses) and stops producing surfactant causing alveolar collapse
decreases area of pulmonary arterial bed increasing P arterial pressure
decreases cardiac output

6
Q

Types of PE

A
  1. Asymptomatic (60% of people will have micro-emboli)
  2. Common PE
  3. Massive PE (CO affected)
7
Q

Presentation of common PE

A

Sudden unexplained breathlessness
sometimes accompanied by pleuritic pain, heamoptysis and signs of DVT
TACHY, LOCALISED PLEURAL RUB AND COARSE CRACKLES, PYREXIA

8
Q

ECG changes in PE

A
  1. Sinus Tachycardia (by far most common)
  2. New onset AF
  3. Tall peaked P waves (P. Pulmonale) Right axis deviation and R Bundle Branch Block
9
Q

Massive PE presentation

A
sudden collapse/ presyncope
cardiac chest pain and shock
O/E:
raised JVP with a wave
Gallop rhythm
Split Heart Sounds
R Ventricular heave
10
Q

Management of PE

A
  1. ABCDE
  2. Wells Score
  3. Investigations
  4. If confirmed PE rest, anticoagulate.
  5. fibrinolyis or surgery if appropriate
11
Q

Wells Score for PE

A

< 3 = unlikely PE. D Dimer to exclude and consider differentials
>4 = Likely PE- CTPA