Pulmonary Embolus Flashcards
what are some hypercoagulable states
post surgery
malignancy
pregnancy
sepsis
smoking
oral contraceptive + HRT
anti phospholipase syndrome
SLE
what are some risk factors for stasis of blood
long haul travel
immobility
obesity
venous insufficiency/ varicose veins
obstruction: malignancy, obesity, pregnancy
presentation of DVT
unilateral
swelling, tender, red, warm to touch calf
oedema
dilater superfiscial veins
to determine if the leg is swollen need to measure both sides 10cm below tibial tuberosity (>3cm is significant)
who is D dimer unreliable in
those with chronic thromboembolic disease
pregnancy
how do you diagnose DVT
doppler USS
what investigations should be done in suspected PE
DVT
V/Q scan
CTPA
ABG
how can you calculate alveolar PO2
20 - pCO2a/0.8
what is the Aa gradient
PO2A - PO2a
can be used to determine if there is V/Q mismatch by AGB
what is initial management for a PE
anticoagulation - apixaban or rivaroxaban
isn’t for thrombolysis but to prevent further clots
can be done if there is suspicion of DVT/PE but delay for a scan
what is a massive / high risk PE
acute PE with circulatory collapse
how are massive PEs managment
thrombolysis (alteplase)
what is the pulmonary embolism severity score
estimation of 30 day mortality for PE
how long should longer term anticoagulation be used post PE/DVT
clear cause/ provoked and no recurrence - 3 months
unclear cause/ irreversible / reccurence - 6 months
what can be done for those with PE/DVT who cannot take anti-coagulants
inferior vena cava filter
what can be done to treat DVTs
catheter directed thrombolysis
