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16 Cards in this Set
- Front
- Back
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What are the components of Vischow's triad for DVT?
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Stasis
Endothelial Injury Hypercoagulable state |
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What are clinical symptoms of a DVT? What are some signs?
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Swelling, pain, erythema, and warmth in the leg.
Homan's sign- pain with dorsiflexion Moses' sign- pain with compression Chord- palpable clot |
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What are symptoms of a PE?
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Dyspnea
Pleuritic pain Hemoptysis Circulatory collapse |
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What are the rule out criteria for a PE?
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Less than 50
HR less than 100 O2 Sat greater than 95 No hemoptysis No estrogen therapy No prior DVT or PE No leg swelling No surgery or trauma w/in last 4 weeks |
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How would arterial blood gas be used in PE diagnosis?
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Widened A-a gradient would be present in a PE.
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How would D-dimer or troponins be used in PE diagnosis?
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D- dimers detect fibrinlysis from a clot formation. Has a high negative predictive value.
Troponins detect strain on the right heart. Positive troponins indicate a worse sign. |
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What are EKG findings in PE? what is the rare, but serious finding?
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Sinus tachycardia, atrial tachyarrhythmia, non-specific changes.
S1Q1T3- indicates strain on the right heart. |
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What are CXR findings for a PE?
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Atelectasis
Pleural effusion Consolidation Prominent central arteries Decreased pulmonary perfusion in an area- Westermark's |
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What is the gold standard for PE diagnosis? Why is it rarely used?
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Pulmonary angiography
Not used because of invasiveness and risk of damage. |
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What are Wells criteria for diagnosis of acute PE?
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Signs and symptoms of DVT- 3 points
PE is more likely than other diagnoses- 3 points HR > 100 bpm- 1.5 points Immobilization/ surgery- 1.5 points Previous DVT or PE- 1.5 points Hemoptysis- 1 point Cancer- 1 point Low risk < 2 Medium risk 2-6 High > 6 |
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What are the clinical steps following clinical suspicion of pulmonary embolism?
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Low suspicion- D-dimer. If normal, no treatment. If abnormal, get CXR done.
High suspicion- initiate treatment and get CXR done. If abnormal move on to CT. If CXR normal, move to V/Q scan. |
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How is a PE prevented in susceptible patients?
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Heparin for 5 days
Warfarin for the last 2 until reaches therapeutic level |
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How is a "massive" PE determined?
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Not based on size- based on effects to the patient.
Hypotension, tachycardia, O2 saturation and temp determine. |
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What are the absolute contraindications to thrombolysis? Relative contraindications?
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Absolute- hemorrhagic stroke, cranial surgery, active internal bleed.
Relative- thrombocytopenia, trauma, recent bleed, other stroke, severe hypertension, CPR, recent surgery, pregnancy. |
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What is done for a potential PE patient who cannot undergo anticoagulation? What is the last resort?
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Inferior vena cava filters.
Last resort- pulmonary embolectomy. |
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What is the treatment after a PE is diagnosed? What should change if become hemodynamically unstable? What about right heart dysfunction?
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Anticoagulation.
In unstable patient, give fluid and vasopressors. In right heart dysfunction, consider thrombolytic therapy. |
