Pulmonary Embolism

• What is a pulmonary embolism (PE)?


  A blood clot in the pulmonary arterial vasculature
• How does a pulmonary embolism typically occur?


  When part of a lower limb deep vein thrombosis (DVT) breaks off and travels to the lungs
• What are key symptoms of a pulmonary embolism?


  Sudden-onset shortness of breath, pleuritic chest pain, and haemoptysis
• What signs may indicate a deep vein thrombosis (DVT) in a patient with PE?


  Unilateral leg swelling
• What investigations are important if a PE is suspected?


  ECG, chest X-ray, CT pulmonary angiogram (CTPA), and echocardiogram
• What is the purpose of a D-dimer blood test in suspected PE cases?


  To risk stratify and help rule out PE
• What is the emergency management for a massive PE?

  Resuscitation and thrombolysis
• What does the PE Severity Index (PESI) score assess?


  Severity of PE based on 11 factors
• What are the estimated 30-day mortality rates for PE severity classifications?


  0.7% in very low risk to 25% in very high risk patients
• What indicates a high-risk patient for PE?


  Haemodynamically unstable patients require admission
• What is a marker of high-risk patients in PE?

  Right ventricular strain
• What is the typical triad of symptoms for PE?


  Sudden-onset shortness of breath, pleuritic chest pain, and haemoptysis
• What does the presence of cough without haemoptysis indicate?


  Cough may also be present in PE
• What symptoms indicate a massive PE?


  Syncope or pre-syncope
• What can right ventricular ischemia lead to?


  Retrosternal chest pain
• How may small PEs present?


  Asymptomatic and detected incidentally on imaging
• What signs should be looked for on examination of a PE?


  Tachypnoea, crackles on auscultation, tachycardia, hypoxia, and low-grade pyrexia
• What are signs of massive PE on examination?


  Hypotension, cyanosis, and signs of right heart strain
• What is the Wells score used for?


  To risk stratify patients with a suspected PE
• How many points are allocated for clinical signs and symptoms of a DVT in the Wells score?


  3 points
• What does a Wells score of 4 or less indicate?

  PE unlikely, do a D-dimer
• What should be done if a D-dimer is raised?


  Further investigate with a CTPA
• What may an ECG show in a massive PE?


  Evidence of right-heart strain
• What is the classic ECG finding in PE?


  S1Q3T3 pattern
• What does a normal ABG indicate in PE?


  It may show type 1 respiratory failure and/or respiratory alkalosis
• What is the negative predictive value of a D-dimer test?


  95% negative predictive value
• What may a full blood count (FBC) show in underlying malignancy?


  Anaemia or thrombocytosis
• What is the purpose of U&Es before a CTPA?


  To assess renal function
• What is the role of LFTs in PE management?


  To assess suitability for anticoagulation
• What is the purpose of a coagulation screen before starting anticoagulation?


  To establish a baseline
• What does troponin assess in PE patients?


  Myocardial damage
• What is typically seen on a chest X-ray in PE?


  Typically normal but helpful in ruling out other conditions
• What is the diagnostic test of choice for a PE?


  CT pulmonary angiogram (CTPA)
• What is a V/Q scan preferred for?


  In severe renal impairment or contrast allergy
• What is the purpose of an ultrasound doppler of the lower limbs?


  To investigate for an underlying DVT
• What is the role of a transthoracic echocardiogram in PE?


  To investigate for right heart strain
• What conservative management is provided for hypoxic patients?


  Oxygen therapy
• What is the purpose of fluid resuscitation in PE management?


  To support hypotensive patients
• What should patients be educated about when starting anticoagulation?


  To ensure they have an alert card
• What may low-risk patients be suitable for?

  Discharge with anticoagulation and outpatient follow-up