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29 Cards in this Set
- Front
- Back
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wells criteria
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3- cant be explained by anything else
3-physical exam is highly suspicous, or found DVT (sob, hemoptysis) 1.5-tachycard 1.5-immobilized or post op 1.5-prior PE or DVT 1-cancer 1-hemoptysis |
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westermarks sign
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seen on chest x ray
reduced peripheral vascularity prominence of pulm art |
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hamptoms hump
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-wedge shaped infiltrate at lung base with apex pointing towards the hilum
-seen with PE and infarction |
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virchows triad
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-stasis
-hypercoagulability -endothelial injury |
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wackers triad
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-increased LDH
-increased bilirubin -normal SGOT (aka AST) |
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mcconnells sign
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-echocardiograph with right vent free wall hypokinesis with preserved motion of the apex in the setting of massive PE
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first test for PE
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ct- good as long as dealing with larger clots, also assesses for other diseases that could cause acute CP and SOB, shows intraluminal fillling defects.
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if you could not give a PE pt dye, do a
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V/Q lung scan- look for ventilation to match perfusion. in PE, vent remains the same bu there is no perfusion
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gold standard for PE study
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pulmonary arteriography
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lab study for PE
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D-dimer- a breakdown product of crosslinked fibrin, positive in the setting of a clot. (however,not totally specific because it is also pos for cancer, post op, etc)
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tx of PE
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LMWH- equally efficacious to unfractionated hep but better because lower incidence of HIT and you dont have to check blood tsts as freq. also better bioavail and predictability.
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drug of choice in pregnant women
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LMWH, coumadin is teratogenic
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vena caval interruption
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used to tx pts who have contraindication to anticoagulation.
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what percentage of PE develop from DVT?
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95%
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criteria for diagnosing pulm htn
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resting mean pulm art pressure of 25mmHg or more, or 30mmHg + during exercise.
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28 yo pt was diagnosed with idiopathic pulm HTN, what signs and symptoms?
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SOB, intermittent hemoptysis, JVD and HJR (increase in venous side), RV lift, lower extremity edema, enlarged heart on xray, EKG shows signs of R axis deviation, cardio ultrasound shows RV and RA bigger than L.
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pulmonary HTN classification
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DANA, 1, 1', 2, 3, 4, 5
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DANA 1, 1'
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1 PAH:
-idiopathic -or arterial HTN related to HIV or scleroderma 1' includes pulmonary veno-occlusive disease, pulmonary capillary hemangiomatosis. know that the prob is in the pulm vessels!! |
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treatment for 1 or 1'
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prostanoids, phosphodiesterase 5 inhibitors, endothelin 1 receptor antagonists
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2
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due to underlying heart disease
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treatment of 2
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treat the heart disease
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4
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clots- chronic thromboembolic disease
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4 treatment
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anticoagulation, thrombectomy
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5
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misc, Gaucher disease, Langerhans, Lymphangioleiomyomatosis. treat the underlying disease
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on chest xray of smoker with hemoptysis and SOB there was complete opacification of the right hemithorax, what could this mean?
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-atelectasis (this is what is was because it pulled all the structures TOWARD it)
-pleural effusion (not this, because this would have pushed the heart and other structures AWAY from it) |
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how could you get complete atelectasis of the right lung?
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there must be an obstruction in the RMB-- do a bronchoscopy! you see a tumor, which could be treated with external beam radiation, argon plasma coagulation, chryotherapy, electroportary, brachitherapy, laser, stenting
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most commonly done bronchoscopy
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flexible, most commonly done for diagnostic (not therapeutic) purposes.
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name things that can be done with a flexible bronchoscopy for diag purposes
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-direct vis
-bronchial washings -bronchial brushings -bronchial biopsies -transbronch biopsies -endobronch biopsies -bronchioalveolar lavage |
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therapeutic purposes of bronchoscopy
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-volume reduction
-stenting |
