PE

• Other than the first line drugs, what may you consider for DVT management?

  Compression stockings

  LMWH

  Warfarin
• Why would you do clotting tests for a DVT?

  Baseline results before starting anti-coags
• What blood tests are done for a DVT?

  FBC

  Urea/creatinine

  LFTs

  Clotting tests - PT/aPTT

  D-dimer
• What are the consequences of chronic thromboembolic pulmonary HTN?

  Right ventricular dilation

  Tricuspid valve regurgitation

  Right ventricular failure

  Heart ischemia
• WHat are some complications of PE?

  RH failure

  Chronic thromboembolism

  Pulmonary HTN

  Atelectasis

  Pleural effusion

  Pulmonary infarction

  Arrythmia
• What main clinical signs and symptoms would be seen in a massive PE?


  Haemodynamic instability

  Hypotension
• What are the 3 main DOACs?

  Rivaroxaban

  Apixaban

  Dabigatran
• What blood test is done to calculate INR?


  Prothrombin time
• WHat may be seen on a cardiac exam for PE and why?

  Raised JVP - due to RH failure
• What are some ECG findings that may appear due to complications of a PE?

  RV strain - T inversion V1-V4 and inferior leads, ST depression

  RA dilatation - right axis deviation
• Why is there a V/Q mismatch in PE?

  Emboli blocks blood flow to some tissue
• What % sensitive & specific is D-Dimer?

  Sensitivity: 95%

  Specific: 50%
• What might you look for on a CTPA?

  Bulging vessels

  Artery abnormally connected to a vein

  Blood clot

  Narrowing of vessel wall

  Assess blood flow to lungs
• Why is previous surgery/immobilisation a RF for PE?

  Decrease activity = blood pools = stasis (Virchow's triad)

  Surgery = endothelial damage (Virchow's triad)
• How many things does the Well's Score for PE assess? and what are they?

  7

  Signs and symptoms for DVT +3

  Ddx less likely than PE +3

  Tachycardic +1

  Immobilisation >3 days, surgery in past 4 weeks +1.5

  Previous DVT/PE +1.5

  Haemoptysis +1

  Malignancy +1
• What is Pleural Rub?

  Sqeak/grafting sound due to contact between ischemic tissue and pleura
• If a PE pt is hypotensive what does this suggest?

  Massive PE

  RV strain
• What emboli usually causes a PE?

  Thrombus - thromboemboli
• What is the PERC rule and how do you get a negative result?

  Pulmonary embolism rule-out criteria

  All criteria must be absent to have a negative result
• What does a 2-level PE wells score consist of?

  Signs and symptoms of a DVT

  Alternative diagnosis of PE is less likely

  HR >100

  Immobilisation >3 days or surgery in the last 4 weeks

  Previous DVT/PE

  Haemoptysis

  Malignancy
• What would a 2 level PE wells score be for a likely PE?

  >4 points
• What would a 2 level PE wells score be for an unlikely PE?

  <4
• What is done if a PE is likely (>4 points)?

  Immediate CTPA (if not possible DOAC is given)
• What if the CTPA is negative?

  Consider proximal leg vein USS is DVT is suspected
• What is done if a PE is unlikely (4 points or less)?

  Arrange D-dimer test
• If there is a strong suspicion of Pe but a delay in the scan what do you do?

  Start on apixaban immediately
• What is the management for a patient with a massive PE + hypotension?

  Thrombolysis
• What is the treatment for a 'provoked' PE?

  Apixaban for 3 months
• What is a 'provoked' PE?

  Due to an obvious precipitating event e.g. immobilisation after a major surgery
• What is an 'unprovoked' PE?

  No obvious precipitating event
• How is an 'unprovoked' PE managed?

  Apixaban for 6 months