Pulmonary Embolus Flashcards Preview

Clin Med I - Pulmonary > Pulmonary Embolus > Flashcards

Flashcards in Pulmonary Embolus Deck (34):
1

What is a pulmonary embolus (PE)?

- blockage of one or more pulmonary a. (large or small)

2

Where do 5% of PE's occur?

- bifurcation of the pulmonary a.

3

**What is the MC source of PE?**

- pelvic/deep thigh v. clot

4

What are the other uncommon causes of PE?

- air
- amniotic fluid
- fat
- FB/septic
- parasite eggs
- tummor

5

How do 50% of PE patients present?

- asymptomatically

6

What is the pathophysiology of PE?

- clot obstructs pulm a. which increases pulm vascular resistance
- vasoactive substances released which further increase pulm vascular resistance
- increased pulm vascular resistance leads to V/Q mismatch
- V/Q mismatch impairs gas exchange

7

signs and symptoms of PE

- dyspnea (shortness of breath, SOB)
- pleuritic chest pain-
- hemoptysis
- cough
- LE pain/swelling
- sense of impending doom
- syncope
- palpitations

8

What are the risk factors for PE?

- *Virchow triad* (venous stasis, vessel wall injury, hypercoagulability)

9

What are the general findings on PE exam?

- dyspnea or pleuritic pain
- anxious
- cyanosis

10

What are the vital finding on PE exam?

- tachypnea
- tachycardia
- hypotension

11

What are the ascultative findings on PE exam?

- nothing vs. wheezing/rales
- tachycardia

12

What are the findings on the extremities on PE exam?

- pain
- swelling
- Homan's sign

13

How is a diagnosis of PE made?

- PERC
- Wells Criteria

14

What are the CXR findings on PE exam?

- Fleischner sign
- Westermark sign
- Hampton hump

15

What is Fleischner sign?

- seen on CXR
- distended central pulmonary artery d/t presence of a large clot

16

What is Westermark sign?

- seen on CXR
- oligemia (less vascular) distal to the embolism

17

What is a Hampton hump?

- seen on CXR
- pleural-based wedge shaped consolidation found anywhere in the lung

18

What is the work-up for PE?

- *D-dimer
- CT Angiography (CTA)
- V/Q Scan
- ECHO (US)
- labs as dictated by DDX

19

What is the treatment for PE?

- anticoagulation
- thyrombolytics/thrombectomy
- IVC filter

20

What is the anticoagulation therapy for PE?

- coumadin/warfrin + LMWH x 5d or until INR b/t 2-3
- factor Xa inhibitors (newer agent - preferred)

21

How long does anticoag therapy for PE last?

- 3-6mo

22

What is the anticoag treatment for moderate to severe cases of PE?

- heparin

23

What are the strongest predictors of PE?

- (+) hx DVT/PE
- metastatic disease

24

What are risk factors of PE?

- chemo & radiation
- central venous access device
- Hb < 10 & WBC > 11 = 2x risk
- platless > 350

25

What patient population is 4x more likely to have a DVT or PE?

- 3rd trimester pregers
- post-partum

26

Why is it that the patient pop who is 4x more likely to have DVT or PE gets one?

- hypercoagulable state
- additional risk : preeclampsia, c-section, anemia, hemorrhage, post partum infection, & IVF
- compression of iliac v. from gravida uterus

27

When is a D-dimer useful in the dx of PE?

- only when negative

28

What do you do with a positive LE US in the patient population that is 4x more likely to have a DVT/PE?

- treat

29

______ (test) is preferred over ______ (test) in the patient population that is 4x more likely to have a DVT/PE because it is ______ sensitive with _____ radiation.

- CTA
- V/Q Scan
- more
- less

30

What is the plan for a PE diagnosis?

- uncomplicated cases can go home
- pregers or CA admitted

31

**Who are at risk for PE?**

- cancer patients

32

**What is the most common CC of PE?**

- dyspnea

33

**What does an EKG read for a PE?**

- S1Q3T3

34

pulmonary embolism (DDX)

- MI
- PNA
- effusion
- pericarditis
- PTX
- costochondritis