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29 Cards in this Set
- Front
- Back
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1. Next step with high suspicion of PE?
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a. Empirical systemic anticoagulation w/confirmatory imaging pending.
b. PE is very likely w/the sudden onset of chest pain and SOB in a pt w/o pulmonary or cardiac pathology. c. The decision to initiate systemic anticoagulation w/o a confirmed dx of PE is justifiable based on high clinical suspicion and the absence of contraindications to anticoagulation. |
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2. Why is it important to use early aggressive anticoagulation w/PE?
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a. Bc these pts are less likely to experience tx failure or develop recurrences.
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3. Venous Duplex Imaging?
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a. An accurate, non-invasive imaging modality combining U/S and Doppler technology to assess the patency of veins and the presence of blood clot in veins.
b. It is especially useful for the lower extremities. |
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4. V/Q scan (ventilation-perfusion)?
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a. A radioisotope scan used to ID V/Q mismatches, which can indicate PE and other pulmonary conditions.
b. Results must be interpreted based on coexisting pulmonary pathology and the clinical picture. |
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5. Utility of CT for PE?
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a. A vascular contrast study involving CT imaging w/a sensitivity for PE detection ranging widely from 64%-93%.
b. It is highly sensitive for PE involving the central pulmonary arteries but less sensitive for subsegmental clots. c. Some advocate that it not be used as the initial imaging study and that it is perhaps best used w/venous duplex or pelvic CT venography for better accuracy. |
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6. What is considered the Gold Standard for diagnosis of PE?
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a. Pulmonary angiography. (~96% accurate).
i. Carries a false-negative rate of 0.6%. |
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7. Benefit of Pulmonary angiography for PE?
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a. Highly accurate.
b. Especially has a greater sensitivity than CT for sub-segmental and chronic PE. |
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8. What are the significant drawbacks to Pulmonary angiography for PE?
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a. Major procedural complicate rate of 1.3%.
b. Mortality rate of 0.5%. c. Time delay associated w/the procedure. |
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9. Utility of Thrombolytic therapy for PE?
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a. Thrombolysis for PE has survival advantages in pts w/massive PE, esp when it is associated w/right heart dysfunction.
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10. Most commonly used agent to tx PE?
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a. TPA is the most commonly used agent and may be given systemically or by catheter-directed infusion into the clot.
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11. Contraindications to TPA?
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a. Recent major surgery (such as within a 10-day period
b. Recent severe head injury c. GI bleed |
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12. Pulmonary embolectomy?
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a. Surgical retrieval of clots in the pulmonary artery through a median sternotomy, requiring cardiopulmonary bypass.
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13. Major indication for pulmonary embolectomy?
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a. Massive PE w/hemodynamic instability and hypoxia, where thrombolytic therapy is contraindicated.
b. It is associated w/30-60% mortality. |
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14. Virchow’s triad for development of acute thromboembolic events?
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1. Stasis
2. Hypercoagulability 3. Vein wall injury. |
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15. Incidence of DVT in general surgery pts?
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a. 25%, w/most being asymptomatic.
b. Most are tibial level veins. However, involvement of femoral and/or iliac veins dramatically increases the risk of PE and sx, such that approximately 30-50% of these pts may develop PE. |
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16. What should all pts w/documented DVT and PE undergo tx with?
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a. Systemic anticoagulation therapy w/heparin infusion, oral warfarin, or subq low-molecular-weight heparin (lovenox).
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17. Duration of therapy for uncomplicated DVT?
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a. 3 months.
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18. Duration of therapy for pts w/PE and no identifiable hypercoaguability state?
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a. 6 months.
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19. Duration of therapy for pts w/PE and identifiable hypercoagulability?
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a. Should be considered for lifelong therapy.
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20. 3 main indications for placement of vena cave filter (Greenfield)?
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a. Recurrent PE despite adequate anticoagulation
b. Complications from anticoagulation c. Contraindication to anticoagulation |
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21. Efficacy and risks with unfractionated heparin?
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a. 6% recurrence
b. 3% major bleeding c. 1-3% risk of HIT. |
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22. Efficacy and risks with LMWH?
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a. 3% recurrence
b. 1% major bleeding c. Associated w/lower risk of HIT. |
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23. Efficacy and risks with Thrombolysis therapy?
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a. Indicated for iliofemoral DVT.
b. Contraindicated in recently postoperative pts or after recent head trauma or GI bleeds. |
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24. With respect to DVTs, when is systemic thrombolytic therapy indicated?
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a. Only if pts have proven proximal DVT.
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25. Sensitivity/specificity of D-Dimer levels?
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a. D-dimer levels are elevated in 99.5% of all pts w/DVT/PE. So highly sensitive.
b. However, also elevated following trauma and surgery- So not specific. |
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26. Pathophys of Heparin-induced Thrombocytopenia?
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a. Usually an IgG-mediated reaction.
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27. Is heparin contraindicated in pregnancy?
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a. No, it does not cross the placenta.
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28. Note: Upper extremity DVT (such as subclavian vein thrombosis) carries a much higher PE risk than lower extremity DVT.
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28. Note: Upper extremity DVT (such as subclavian vein thrombosis) carries a much higher PE risk than lower extremity DVT.
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29. Complete.
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29. Complete.
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