20. Pulmonary embolism - Sarm

• Most common cause of pulmonary embolism is?

  blood clot
• what phase of pregnancy is most likely leading to PE?


  c-section
• origin of pulmonary embolus?

  DVT or lower limbs
• PE - clinical presentation

  • chest pain - pleuritic
  • sharp
  • worse in inspiration
  • sudden onset of dyspnea is due to hemodynamic collapse
• PE classic presentation - sudden onset of

  • pleuritic chest pain
  • SOB
  • hypoxia
• Geneva criteria - low score = low probability of getting PE
• Well's criteria/score - score of 1 or lower = less chance of PE
• high d-dimer is consider hypercoagulative states
• When should D-dimer not be used to assess PE?

  when clinical probability of PE is high
• PE EKG show?

  sinus tachycardia
• PE tests - not PE

  • Geneva - 1 or lower
  • Well's criteria - 0-3
  • Perc
  • low pretest probability
  • all of the above criteria met
• Is the patient hemodynamically stable

  • stable - undergo CT to confirm diagnosis
  • unstable
  • BP < 90/ > 40
  • give IV heparin (anticoagulation)
  • echocardiography
• Gold standard for identifying PE?

  pulmonary angiogram

  • but rarely used because invasive
• Treat all PE pt with?

  anticoagulants - LMWH

  • if C/I - use
  • fondaparinux
• If PE is massive - treat with?

  Thrombolysis - tPa
• Management of PE with

  • first use LMWH
  • then use warfarin - aim INR is 2-3
• Surgical management for PE?

  thrombectomy
• IVC filter for management of PE is for?


  patient CI to anticoagulation