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34 Cards in this Set
- Front
- Back
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What is a pulmonary embolus?
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Anything that enters the pulm circulation and alters gas exchange or mechanics
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What are 3 things that can embolize to the pulm circ?
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-Clot
-Fat -Amniotic fluid |
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What is the % mortality of PE if unrecognized?
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30%
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In how many cases of PE is the diagnosis missed?
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2/3
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What are the CLASSIC signs/sx of PE?
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-Dyspnea/tachypnea
-Pleuritic chest pain -Hemoptysis |
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Where do 80% of PEs come from?
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DVT
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What is Virchow's triad?
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-Stasis
-Hypercoagulable -Intimal injury |
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What is an iatrogenic cause of intimal injury?
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Femoral central veinous line
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What Prelim test for PE is NOT sensitive and why?
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Chest Xray - normal in 30%
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What are 2 more specific but rare findings in PE on CXR?
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-Hampton's hump
-Westermark sign |
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What is Hampton's hump?
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Wedge-shaped density at lung periphery indicating lung ischemia
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What is Westermark sign?
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Cutoff of the pulm artery branch
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What can be seen on ECG in PE?
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-Sinus tachycardia
-S1Q3T3 pattern |
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What is the S1Q3T3 pattern?
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-Normal S in lead I
-Qwave in lead III -Inverted T in lead III |
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What are 2 findings on the ABG that indicate PE?
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-Hypoxia (low PO2)
-Elevated Aa gradient |
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How do you calculate the Aa gradient?
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[150 - 1.2(PCo2)] - PO2
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What is a normal Aa gradient?
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Age/4 + 4
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What % of PE patients have a normal Aa gradient though?
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10-15%
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How can you determine if a patient has a PE?
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Use decision tools like Wells Criteria
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What score indicates low vs intermed vs high probability of PE using Wells?
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<2 = low
2-6 = intermed >6 = high prob |
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What should you do if a patient has a LOW probability?
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D-dimer - if neg, PE is ruled out
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What should you do for patients with intermed or high prob of PE?
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Imaging
-VQ scan -Helical CT |
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What type of interpretation does a radiologist give of a VQ scan?
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Same as from clinical suspion
-Normal -Low prob -intermed prob -high prob |
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When is a VQ scan most useful?
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When a patient has a low clinical probability; the higher the prob is, the less useful a VQ scan is - do a helical CT
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What would help u decide whether to order a VQ scan or CT?
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VQ - if CXR is normal
CT - if CXR is abnormal |
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What will the helical CT show in PE?
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The clot in the pulmonary vasculature
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What is a downside of the helical CT scan?
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Requires contrast dye
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What is the historical gold standard for PE?
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Pulmonary angiography
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Why is pulmonary angiography so rarely used now?
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Invasive test
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What are the 4 main meds used for treating PE?
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-Oxygen
-IV fluids/pressors if necess -Heparin bolus/drip or Lovenox -Thrombolytic therapy |
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Why isn't Heparin or SQ Lovenox sufficient in itself?
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It only prevents FURTHER clot from forming
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What does Thrombolytic therapy do for PE?
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Dissolves the clot
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What is the risk in giving TPA for PE though?
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Embolus to the CNS or hemorrhage
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For what patients is thrombolytic therapy reserved?
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Cardiopulmonary collapse
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