Wannamaker 10-4-07 Pe

Front 1

Virchows Triad

Back 1

Stasis, injury , hypercoaguable state

Front 2

risk factors or venous thromboembolism

Back 2

age > 40 yrs
history of venous thromboemb
surgery with > 30 mins anesthesia
prolonged immonbiliaztion
CVA
CHF
Cancer
frature of pelvis, femur, or tibia
obesity
pregnancy or recent delivery
estrogen therapy
IBD
Genetic

Front 3

venous thromboembolism:

Preventable deaths associated with _________ rather than treatment failure

Back 3

missed diagnosis

Front 4

___% of patients with DVT (and no symptoms) will have a positive lung scan

Back 4

40

Front 5

Poor prognosis: Echo with RV hypokinesis in normal ______

Back 5

systemic B/P

Front 6

____% of patients with PE had abnormal leg u/s

Back 6

29

Front 7

Presentation of PE

Back 7

Dyspnea
Tachycardia

Front 8

3.0 points in favor of predicting PE

Back 8

clinical signs and symptoms of DVT

Front 9

"Points" for probability of having PE

Back 9

<2.0 - low
2.0 - 6.0 intermediate
>6.0 high

Front 10

TEST QUESTION

Degradation products of cross-linked fibrin

Back 10

D Dimer

Front 11

Role of D-Dimer

Back 11

Rule out thromboembolism

Front 12

TEST QUESTION

If D-Dimer is positive, do you have PE?

Back 12

D-Dimer is Highly sensitive
Nonspecific
Age, pregnancy, trauma, cancer, postop, inflammatory states


(look this up)

Front 13

What is significance of a normal Ventilation-Perfusion (V/Q) scan

Back 13

Rules out Pulmonary Embolism



Radiologist never says it's normal. Always low, int, high probabliity.

Front 14

TEST QUESTION

Computed Tomography (CT) scan
Sensitivity decreases, as vessel size ________

Back 14

decreases

Front 15

TEST QUESTION

Computed Tomography (CT) scan
Negative study not as definitive as _______

Back 15

Normal V/Q scan

Front 16

TEST QUESTION

Relative/absolute contra-indication of CT scan:

Back 16

Renal failure


Contrast media is nephrotoxic

Front 17

Source of most emboli to Pulmonary arteries

Back 17

Deep veins of the legs

Front 18

Patients without signs or symptoms: ____% have DVT

Back 18

10-20

Front 19

Patients with Pulmonary Emboli: ____% have DVT

Back 19

50

Front 20

Pt with suspected PE:
doc can withhold anticoagulation if .....

Back 20

Negative study with Negative CT,

Front 21

Underutilized Gold Standard of diagnosing PE

Back 21

Pulmonary Angiogram

Invasive
Death rate 0.5%
Major non-fatal complication: 0.8%

Front 22

Acute Thrombotic state messes up coagulation values how?

Back 22

Depresses Protein C, Protein S, Antithrombin III

Front 23

B/c Acute Thrombotic state messes up coagulation values, what do you look for instead?

Back 23

Lupus anticoagulant
Hyperhomoceistinemia: Factor V Leiden mutation

Front 24

Treatment of PE

Back 24

1) Heparin
Loading dose: 5,000 – 10,000 units
Infusion: 18 units/kg/hour (Max 1600 units/hour)
Monitor PTT
Resistance (>50,000 units/24 hr) monitor plasma heparin level, also w prolonged PTT at baseline
2) LMWH
i.e. Enoxaparin (Lovenox) 1mg/kg subQ bid

Front 25

TEST QUESTION

other treatments of PE

Back 25

1) Inferior vena cava filters

2) Warfarin 5mg daily

Front 26

TEST QUESTION

Inferior vena cava filters have the Same mortality with anticoag as anticoag alone
What is Indication for this:

Back 26

active bleeding, recurrance despite anticoag

Front 27

TEST QUESTION

How long do you take Warfarin 5mg qd?

Back 27

6 month after 1st episode,

lifelong after second episode

Front 28

Warfarin Dosage adjusted to maintain PT. INR ___?

Back 28

2-3
(Heparin drip until INR gets to 2-3, then put pt on warfarin)

International Normalization Ratio

Front 29

TEST QUESTION

Another possible treatment for Hemodynamically unstabile pt.

"the clot is so big..."

Back 29

Thrombolysis


others still (not underlined):
Transvenous catheter embolectomy - suck out the clot
Open embolectomy