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39 Cards in this Set

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If you suspect a PE, what should you do before further tests?
Start IV heparin!
Diagnostic Test for PE?
VQ Lung Scan
So PE's can present very differently...what are three factors that dictate to a large degree how they present?
Size of Clot
Degree of Arterial Obstruction
Comorbid Conditions
General types of conditions that may precipitate venous thrombosis?
Conditions that inc venous stasis
Conditions the cause endothelial damage
Sub clinical hypercoagulable states
General Effects of PE's?
Inc Pulmonary Vascular Resistance
Impaired Gas Exchange
Alveolar Hyperventilation
Inc Airway Resistance
Dec Pulmonary Compliance
Usual Cause of Death in PE?
Right Ventricular Dysfunction?
Typical Clinical Findings w/ PE?
Unexplained Dyspnea
Chest pain
Tachycardia
Syncope
Rx for Massive PE?
Thrombolysis
Embolectomy
Elements of Massive PE Syndrome?
Systemic Arterial Hypotension
Cardiogenic Shock
At least half of pulmonary vascular affected
Bilateral Clot
Dyspnea
Transient Cyanosis
Often w/o chest pain
Anatomically widespread thromboembolism
Moderate to Large PE Syndrome elements?
RV Hypokinesis on echo
Normal systemic pressure
Elevated Troponin/BNP
1/3 of vascular affected
Risk of recurrence
Rx for moderate to large PE?
Controversial
Toss up between anticoagulation and thrombolysis/embolectomy
Small to Moderate PE Syndrome elements?
Normal Right Heart Fxn
Normal Systemic Pressure
No troponin or pro-BNP release
Rx for small to moderate PE?
anticoagulation
Pulmonary Infarction syndrome?
Usually small PE
Really Painful
Maybe Hemoptysis
Maybe associated w/ larger PE
Fever
Leukocytosis
Elevated ESR
when do the sx's of infarction occur in relation to embolism?
3-7 days
Prognosis of moderate to large PE?
most survive
Most frequent symptom and sign of PE?
symptom: dyspnea
sign: tachypnea
4 kicker Sx's for Massive PE?
dyspnea
syncope
hypotension
cyanosis
3 kickers for distal, small PE?
pleuritic pain
cough
hemoptysis
Problem w/ PE in young, healthy pts?
may simply appear anxious w/ dyspnea on moderate exertion

no other "classic" sx's
Typical Sx's w/ elderly PE pts?
vague chest pain
Tachypneic and Tachycardic
Maybe hypotension, cyanosis, RHF
Non-imaging Diagnostic Tools for PE?
Plasma D-Dimer ELISA level
ABG
ECG
When is D-Dimer indicative of PE?
D-Dimer is >500ng/mL in more than 90% of PE pts
Key to usefulness of D-Dimer level?
It's negative predictive value. D-Dimer is also raised w/ MI's, sepsis, etc, but if its not raised its not PE
Cause of elevated D-Dimer?
Plasmin's breakdown of fibrin
Endogenous thrombolysis (clinically ineffective)
ABG findings w/ PE?
pO2 and pCO2 decreased
little diagnostic utility
ECG findings w/ PE?
Sinus Tach or new onset A-Fib or flutter
S wave in 1, Q in III, inverted T in III
Right axis deviation
T inversion in V1-V4
Noninvasive Imaging Modalities for PE?
CXR
Venous Ultrasonography
Contrast CT
Lung Scan
Echo
Other invasive imaging modality?
Pulmonary Angiography
CXR findings w/ PE?
Normal or near-normal CXR
Focal Oligemia (westermark's sign)
Peripheral wedge-shaped density (hampton's hump)
Enlarged Right Descending Pulmonary Artery (palla's sign)
Venous Ultrasonography findings w/ PE?
Loss of Vein Compressibility
Not super good test: negative in 50% of PE pts
Which imaging study is the new boss? old boss?
Pulm angiography is getting phased out by Contrast CT
One reason why contrast CT is so good?
it establishes alternative dx (pneumonia, emphysema, etc)
Usefulness of Lung Scan and Echo?
bad...50/50 shot or worse
Why is Echo good?
RV dysfxn
Other heart problems
What is the most sensitive imaging study?
Angiography
Primary PE Therapy?
Clot dissolution w/ thrombolysis and embolectomy
Secondary Prevention for PE?
Anticoagulation w/ heparin and warfarin or installing IVC filter
who are the high risk PE pts?
Hemodynamic instability
RV dysfxn
Elevated Troponin due to RV microinfarction