Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
24 Cards in this Set
- Front
- Back
|
Main cause of pulmonary embolism.
Other causes? |
Main cause:
Venous Thrombo-Embolism (venous circuln, thrombosis, embolism) Other sources: Amniotic fluid air fat tumor |
|
|
Virchow's Triad for Pathogenesis for Development of DCT
|
Stasis
Altered Coagulation Intimal Injury |
|
|
Causes of venous stasis.
|
Paralysis (neuropathic, general anesthesia)
Immobilization Bed Rest Inactivity |
|
|
Causes of intimal injury.
|
Trauma (MVA)
Surgery |
|
|
Causes of altered coagulation.
|
Acq'd:
-Mets -Lupus anticoag Inherited: AT (antithrombin), PC (protein C), PS (protein S)deficiencies APC Resistance--found in 5% of population!! |
|
|
What puts everyone at risk for DVT?
|
Age > 40
|
|
|
Main source of DVTs. Which veins specifically?
|
95% of CLINICALLY SIGNIFICANT PE originate from legs.
Thrombi below popliteal vein rarely embolize; particularly superficial femoral vein. Below knee: not DVT Popliteal veins: DVT Superficial Femoral Vein: DVT Femoral Vein: DVT |
|
|
Clinical manifestations of PE
|
-Impaired gas exchange (hypoxia, hypocapnea, hypercapnea)
-Pulmonary Infarct (uncommon) -Pleural Effusion |
|
|
Effect of PE on:
A-a gradient V/Q Cardiac Output |
Increases A-a gradient
Can cause both V/Q mismatch (bronchoconstriction and congestive atelectasis--i.e., localized pulmonary edema near PE), and shunt (intrapulmonary and intracardiac) Also decreases cardiac output |
|
|
Pulmonary embolism _____ results in hypoxia because _________.
|
PE usually results in hypoxia because of dec'd Cardiac Output and/or decreased V/Q
|
|
|
Effect of PE on ventilation. How does this influence PaCO2?
|
Hyperventilation; low PaCO2
|
|
|
Effect of PE on dead space. How does this influence PaCO2?
|
Inc'd dead space; high PaCO2
|
|
|
When does hypercapnea occur in PE?
|
When >2/3 pulmonary circulation occluded an dpatient is unable to increase ventilation (pulm dz, paralysis, sedation)
|
|
|
DCT Diagnosis:
Signs/Symptoms |
Calf Pain/Swelling
Homan's sign: dorsiflex foot and induce pain Note: >90% ARE ASYX! |
|
|
How can ultrasound assist in the diagnosis of DVT?
|
U/S of popliteal vein/artery
Apply pressure If vein does not compress when pressure is applied, a clot is holding it open |
|
|
Why is diagnosis of PE difficult? What symptoms are suspicious for PE?
|
Syx are nonspecific and there is no easy, definitive test.
Clinical suspicion for PE: Syx: Dyspnea*** Tachypnea*** Fainting** Pleuritic Pain** Apprehension Cough Hemoptysis |
|
|
What auscultatory finding is associated with PE?
|
Rales
|
|
|
When is A-a gradient present in PE?
|
When patient is not healthy. A-a gradient almost ALWAYS present in unhealthy patients.
|
|
|
Utility of D-Dimer assay in diagnosing PE.
|
Very high NPV (~98%). Good for ruling out.
|
|
|
What steps would you take in determining PE after a positive D-Dimer assay?
|
V/Q scan or CT Pulmonary Angiogram; if positive-->stop
If negative but have clinical suspicion: Lower Extremity U/S If negative, stop. If positive, treat. |
|
|
DVT Prophylaxis
|
SQ Heparin
Pneumatic compression boots |
|
|
Venous Thromboemolism Treatment:
For DVT For PE For PE + Risk Factor |
Immediate anticoag w/heparin
Heparin + Coumadin at least 5 days Extended anticoag w/coumadin: 3 mos for DVT 6 mos for PE >9 mos for PE + risk factor |
|
|
When should thrombolytics be used in PE?
|
People who are hemodynamically unstable (at high risk of dying)
Allows for more complete resolution of clot Increases risk of significant bleed systemically |
|
|
When is an IVC filter indicated in PE?
|
To prevent clot embolization in pats who can't be anticoag'd, have a large clot burden, and are at high risk of DVT.
|
