pulmonary embolism

• What is a pulmonary embolism?

  Thrombus from a DVT blocks pulmonary arteries
• What is the consequence of a pulmonary embolism on blood flow?

  It reduces blood flow to the lungs
• What heart condition can result from a pulmonary embolism?

  Right sided heart failure
• What are the risk factors for pulmonary embolism?

  • Immobility (long flights/recent surgery)
  • COCP
  • Surgery
  • Obesity
  • Pregnancy
  • Malignancy
  • Polycythaemia
  • SLE
  • Thrombophilia
  • Previous VTE
• What is a common symptom of pulmonary embolism?

  Shortness of breath (SOB)
• What type of chest pain is associated with pulmonary embolism?

  Pleuritic or retrosternal chest pain
• What is another symptom of pulmonary embolism?

  Cough
• What is a symptom of pulmonary embolism that involves blood?

  Haemoptysis
• What vital sign changes may indicate pulmonary embolism?

  Tachycardia and increased respiratory rate
• What investigations are done for a pulmonary embolism?

  1. CXR (initial)
  2. Wells score:

  • >4 likely: perform CTPA
  • ≤4 unlikely: perform d-dimer

  1. D-dimer positive: perform CTPA
• What is the most appropriate investigation for a patient with PE and renal impairment?

  V/Q scanning
• What is a common ECG finding in pulmonary embolism?

  S1Q3T3 pattern
• What other ECG findings may be present in a PE?

  RBBB, right axis deviation, sinus tachycardia
• What must be given to a patient while waiting for CTPA?

  Apixaban or rivaroxaban (1st line)
• What is the management for a pulmonary embolism?

  DOAC (1st line) or LMWH
• What are the management guidelines based on the duration of treatment for PE?

  • 3 months: reversible cause
  • >3 months: irreversible cause (thrombophilia/recurrent VTE)
  • 3-6 months: active cancer
  • Thrombolysis for massive PE + circulatory failure
• What is the ABG finding in pulmonary embolism?

  Respiratory alkalosis (reduced pO2)
• What is the ABG finding in hyperventilation?

  Respiratory alkalosis (increased pO2) with hypocapnia
• How is a pulmonary embolism managed in pregnancy?

  1. Suspect PE: do CXR + ECG, start LMWH
  2. If symptoms present: do duplex US + confirm DVT, continue LMWH
  3. If symptoms not present:

  • Normal CXR: perform V/Q scan + give LMWH
  • Abnormal CXR: perform CTPA + give LMWH
  • If PE not confirmed, stop LMWH