Respiratory Distress/Disorders Ross Final Flashcards
(59 cards)
what is the classic triad of pulmonary embolism?
- Dyspnea
- Chest pain
- Hemoptisis (rare)
How can PE also present outside of classic sxs?
Dizziness
Weak/tired
Decrease exercise tolerance
cough and no other sxs
What is the pathophys of PE?
Virchow’s triad
Inflammation and platelet activation
**Main point is coagulation will outpace fibrinolysis
Patients with no respiratory PMHx will exhibit sxs (i.e. CP and dyspnea) when what percentage of vasculature is occluded?
20%
In severe cases of PE, meaning there is a large occlusion, what can this lead to?
Increased pulm art pressures > RV dilation releasing BNP and troponin > ultimately resulting in cardiogenic shock
**Blood volume stays the same > pulm vasculature is blocked increasing resistance > increasing pressure (same volume in smaller space)
What percentage of PEs progress to cardiogenic shock? Once this occurs what is survival rate percentage?
4-5%
50% survival
Fun fact: What percentage of DVTs are associated w/ PEs even though may be no sxs of PE?
50%
What are the components of the deep venous system?
Popliteal
Iliac aka pelvic per Ross
Superficial Femoral
Deep femoral
*PISD acronym
What is percentage of pts w/ past unprovoked DVT that will have another DVT w/in 10 yrs?
10-15%
PE risk factors (RFs)?
Long travel
Obesity
Smoking
OCP (estrogen)
COPD
Hx of clot ANYWHERE
Cancer
Genetic Leiden factor V and/or protein S
Exam findings for PE?
96% tachypnea (Rs > 16)
58% rales
53% secod heart sound
44% tachycardia > 100 BPM
43% Fever >37.8 C
36% diaphoresis
**Any one of these is enough to consider or r/o PE
Which pts are the PIOPED1 and PIOPED 2 studies aimed at?
*These studies determined risk stratification for PEs
Patients who have sxs concerning for PE
*NOT for pts who have risk of PE but no sxs
Oh you better know the Wells Criteria for PE. Write them out. Chart provided as answer
What about Wells Criteria for DVT
Answer chart provided
*Ross did not stress this as much as PE
What is your next criteria you would use if obtaining a Wells Criteria PE score less than 4 (low to moderate) and what are ALL the criteria that must be met?
PERC (PE r/o criteria)
**If ALL of these are met then chance of PE < 2%, no need for d-dimer
**This is a rule-out criteria, not rule-in
Are there labs (not imaging) that you can use for dx of PE?
NO!
Even a d-dimer is not diagnostic
You have a suspected PE pt who you want to image but they are either pregnant, contrast allergy or have poor renal fx. What imaging can you use instead?
V/Q scan (need CXR as well)
*Not used very often b/c up to 60% of scans are non diagnostic especially if CXR was abnormal or has lung dz. Need to f/u w/ further testing like DVT u/s
What scan is just as good as CTA for PE in pregnant or contrast allergy pts?
MRA
What do you do before ordering a dimer on rotations if you have a pt who is low risk for PE and you cannot use PERC?
Present case to attending before ordering. If positive dimer then you are most likely going to have to CTA pt
What are CXR signs of PE?
Hampton’s hump
Enlarged right descending pulm a.
Westermark’s sign
Truncation of pulm vasculature
what EKG findings (if any) could you find raising suspicion for PE?
Most common is normal EKG
Most common abnormal finding is inverted T in III
then
Wide S in 1, Q in III
*S1Q3T3
What type of pattern can you see on EKG for PE?
“Strain” pattern = poor prognosis
shows assymetric ST depression
You have a high risk PE pt but the CT is negative, what now?
Call the radiologist to review report with him
What are the three categories of clinical PEs?
Massive > syncope and cyanosis
Moderate > sob, +/- plueritic pain & mild low sats
Small > not clinically sig
**Cannot miss the moderate group
