Pulmonary Embolism + Pneumothorax Flashcards
(21 cards)
Name some risk factors for DVT/PE
thrombophilia trauma/surgery contraceptive pill pregnancy malignancy immobility (bed rest, long haul flight) MI vasculitis
What are the clinical features of PE?
Chest pain SOB Tachypnoea Shock --> tachycardia, hypotension Fever Cyanosis Haemoptysis
Which scoring system is used to assess the likelihood of a PE?
Wells’ Score
Which investigation is gold standard for diagnosing PE?
CTPA (CT pulmonary angiogram)
When would a V/Q scan be used as first line to investigate a suspected PE?
Pregnancy (unless haemodynamically unstable, then CTPA should be used as more sensitive)
Allergy to contrast
Renal impairment (contrast)
When should a D-dimer be used?
If Wells’ score suggests PE unlikely
if positive –> CTPA
What is the treatment for patients with a confirmed DVT or PE?
LMWH or fondaparinux
Which treatment should be considered if a patient has a PE and is haemodynamically unstable?
Unfractionated heparin + thrombolysis
Which anticoagulant should be offered following a DVT/PE and for how long?
Warfarin (vit K antagonist) for 3 months then review risk
How can DVT/PE be prevented post-op?
Early mobilisation TED compression stockings Calf muscle exercises SC LMWH perioperatively --> dalteparin (fragmin) DOAC (direct oral anticoagulation)
Give two examples of DOAC and their mechanism of action
Dabigatran - direct thrombin inhibitor
Rivaroxaban/Apixaban - direct inhibitor of activated factor Xa
Who most commonly get pneumothorax?
Tall, thin men
Marfan’s
Smokers/cannabis
Underlying lung disease
What is the difference between primary and secondary pneumothorax?
Primary occurs in normal lungs
Secondary occurs in diseased lungs e.g. COPD
What are the symptoms of a pneumothorax?
Sudden onset pleuritic chest pain and SOB
What signs are seen in pneumothorax?
Hyper-resonance to percussion Reduced or absent breath sounds Tracheal deviation (if tension) Hypoxia Tachycardia Reduced chest expansion Hamman's sign: click on auscultation
Which investigation is usually diagnostic for pneumothorax?
CXR
How are large and small pneumothorax differentiated?
Small = < 2cm rim of air
Large = > 2cm rim of air
- 2cm rim is approximately 50% pneumothorax by volume
- measured at hilar level, NOT apex
What are the features of a tension pneumothorax?
Acute respiratory distress (can lead to cardiac arrest)
Other chest organs pushed away from affected side
Trachea deviated to opposite side
Hypotension
Raised JVP
What is the management of a tension pneumothorax?
Immediate needle decompression
–> large bore IV cannula into 2nd intercostal space, mid-clavicular line
+ oxygen
+ tube thoracostomy to prevent immediate recurrence
What is the management of a primary spontaneous pneumothorax?
< 2cm and no SOB –> oxygen and observe
> 2cm or SOB –> oxygen and needle aspiration (cannula, 2nd intercostal, mid-clavicular)
What is the management of a secondary spontaneous pneumothorax (or if patient over 50)?
Should be admitted even if small and reduced pulmonary reserve
> 2cm or SOB –> chest tube thoracostomy
