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27 Cards in this Set
- Front
- Back
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What percent of the circulation does the pulmonary circulation receive?
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100%
ALL OF IT! |
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What percent of CO goes through the bronchial circulation?
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2%
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What is the arterial source for the bronchial arteries?
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Aorta
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What is the drainage of the bronchial arteries?
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1/3: Azygous vein
2/3: pulmonary capillares (broncho-pulmonary anastamoses) |
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What is the most common source for PE's?
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Deep veins of the legs:
-Femoral -Illiac -Pelvic Not so common: -Subclavian -RA/V |
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What types of people get PE's?
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Hospitalized old people
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What are the components of Virchow's triad?
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YOU SHOULD NEVER FORGET THIS!!!
Stasis Abnormal coagulation Tissue injury |
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What are some common causes of stasis leading to PE?
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Surgery (urologic, orthopedic)
Pregnancy (pelvic vein stasis) CHF Bed rest travel Prior thromboembolism Casts for fractures |
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What are some common causes of abnormal coagulation leading to PE?
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Alteration of female hormones (contraceptives, HRT, pregnancy)
Malignancies Mutations in clotting factors |
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What are some common causes of tissue injury leading to PE?
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Surgery
Trauma IV catheters prior thromboemboli |
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What are the symptoms of a PE?
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Not too terribly specific!
Here's a list, though: -Dyspnea -Pleuritic chest pain -Cough -Hemoptysis -Palpations -Syncope -Leg pain/swelling |
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What are the signs of a PE?
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Not specific!
Here's a list, though: -Tachypnea -Rales -Calf/thigh swelling (good predictor) -Calf/thigh pain (good predictor) |
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What is Homan's sign? What condition is it commonly found in?
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Calf pain on dorsiflexion of the fooot
PE |
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What blood gas finding is classic for PE's?
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Respiratory alkalosis due to increased RR secondary to V/Q mismatch
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Why does hypoxemia occur with PE?
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Blood going through places that there isn't ventilation (lower lobe has high Q. when PE, Q diverted to upper lobe, where V is lower)
Low of pulmonary surfactant in areas of PE Reduced mixed venous O2 contend due to decreased CO |
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What is the physiologic response to PE?
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Disproportionate increase in pulmonary vascular resistance: generalized constriction--> RHF--->decreased LV filling--> decreased CO--> hypotension, shock
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Are EKG and CXR very helpful for making a diagnosis of PE?
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No. they aren't sensitive or specific.
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What is Westermark's sign? When is it seen?
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Decreased vascular markings in an area of lungs.
PE |
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What is Hampton's hump?
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A wedge shaped infiltrate extending to the pleural surface
PE |
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What is the "classic" PE finding on EKG?
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S1, Q3, T3 pattern
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What is the wells score?
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Clinical probability model for PE
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What are the most diagnostic clinical features on the Wells Model?
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In order:
-Clinical signs of DVT -Excluding other causes -Immobilization -Tachycardia -Previously diagnosed PE/DVT |
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What are good diagnostic studies for PE?
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V/Q scan
CT angiography Pulmonary angiography - perform this last...it's invasive |
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Just take a look at the diagnostic map for a PE and think about it.
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WOULDJA LOOKIT THAT!
http://www.youtube.com/watch?v=EF8GhC-T_Mo |
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What are ways that you can prevent PE's in patients?
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Have them walk! (ambulation)
Compression stockings Prophylactic anticoagulations |
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What is the treatment of a PE?
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Supportive therapy
Heparin (reduces morality significantly) Thrombolytics IVC filter |
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What is the long-term treatment of PE?
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Bridge the patient to warfarin
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