Flashcards in VTE Deck (59)
T or F. Bronchospasm and wheezing are seldom a part of VTE
F. Because of the products of platelet products
Why does hypoxia occur with VTE?
initially a V/Q mismatch issue
When should anticoagulation therapy be started if VTE is suspected?
before the diagnosis is confirmed.
S1Q3T3 is an ACUTE setting is indicative of what?
pulmonary embolism (chronically think PAH)
What is the mortality rate of diagnosed PE?
Less than 10% but it bumps up to 30% if undiagnosed
90% of VTE originate where?
deep veins in the legs
Talc emboli are common in which patients?
How are air emboli prevented?
lie patients flat and somewhat on side (Trendelenburg position) to prevent intrathoracic pressure from dropping to much
What is VIrchow's triad?
triad for risk of clot formation
What things promote stasis of blood?
-central venous catheters
What things promote hypercoaguability(genetic)?
-Factor V Leiden
-Protein C and S deficiency
-Antithrombin III deficiency
What things promote hypercoaguability (acquired)?
-pregnancy (estrogen use and pressure on IVC promotes stasis)
What is a type of malignancy especially associated with DVT?
Diseases with increased hypercoag?
**-Heparin induced thrombocytopenia
What things can cause endothelium injury?
How does a pulmonary embolus affect gas exchange?
there is increased alveolar dead space creating a V/Q mismatch and shunting
How does the V/Q mismatch manifest ton testing?
In PE, there is alveolar hyperventilation. Why?
reflex stimulation of J (irritant) receptors
Why is wheezing seen in PE?
there is increased airway resistance due to bronchoconstriction (increased serotonin production locally by the clot)
How is compliance affected by PE?
decreased due to lung edema, lung hemorrhage, or loss of surfactant
How does the circulation compensate?
there is vasodilation of uninvolved vasculature which helps to decrease the increase in PVR and improves V/Q relationship
T or F. A high SaO2 rules out PE
F. This is due to the compensatory effect in pulmonary circulation
But the A-a gradient will be increased
T or F. The A-a gradient is increased in pulmonary embolism
What are the overall respiratory effects of PE?
Tachypnea (increased minute ventilation)
Hypoxemia (V/Q mismatch)
Shunting (in massive PE)
What are the overall gas exchange effects of PE?
-hypocapnia (low PaCO2)
-hypoxemia (low PaO2)
Wide A-a gradient
What are the overall CV effects of PE?
-decrease in CO
-Pulmonary HTN and cor pulmonale (possibly infarction)
What is the gold standard of picking of clots in the pulmonary circulation?
What type of CT scan s used for ruling in/out PE?
What is the most common complaint form a patient with acute PE?
SOB (and tachypnea)