Download Pulmonary Embolism - Cheat Sheet and more Schemes and Mind Maps Cardiology in PDF only on Docsity! Pulmonary Embolism Cause • Pulmonary artery obstruction o Thrombosis from DVT o Fat (surgery), amniotic fluid (pregnancy), tumour (cancer), air (trauma) Pathophysiology o Causes reduced blood flow to lungs resulting in VQ mismatch o A massive PE will increase right ventricle afterload and cause right ventricular failure leading to haemodynamic compromise Presentation • Symptoms o Pleuritic pain and haemoptysis o Isolated SOB/dyspnoea/cough o Circulatory collapse and LOC (a massive PE)/light headedness Signs o DVT (cause) o Hypotension, raised JVP, parasternal heave (RV failure) o Tachypnoea (most common sign), tachycardia o Decreased O2 (VQ mismatch) o Pleural rub on auscultation Investigations • NOTE: IF PE SUSPECTED, START DOAC IMMEDIATLEY • Bedside o Bloods: FBC, U&Es, LFTs, clotting, CRP, d-dimer o ABG o Also: serial troponins to exclude ACS o ECG essential for chest pain • Sinus tachycardia – most common ECG finding in PE • S1Q3T3, RBBB, RAD, T inversion o Special tests: D dimer IF WELLS SCORE IS <4 • If positive, then CTPA or VQ • If negative, then stop DOAC • Imaging o CXR essential for chest pain • Usually normal in PE (may see atelectasis or wedge-shaped infarct) o May do an echo for RVF o CTPA IF WELLS SCORE >4 OR IF D DIMER IS POSITIVE (requires contrast) • If positive, then continue DOAC • If negative, then stop DOAC • If negative but DVT suspected, do leg USS o VQ IF RENAL IMPAIRMENT OR IV CONTRAST ALLERGY OR PREGNANT • CTPA requires contrast so VQ scan instead • NOTE: cancer screening no longer routine after a PE Wells PE is used to determine the investigations used based on likelihood of PE • Suspected DVT: 3 • PE most likely diagnosis: 3 • Tachycardia: 1.5 • 3 days immobilisation or surgery in past thirty days: 1.5 • Previous thromboembolism (DVT/PE): 1.5 • Coughing blood (haemoptysis): 1 • Cancer/malignancy: 1 Wells PE summary: • If PE suspected, start DOAC • If Wells PE <4, do d dimer • D dimer negative then stop DOAC • If Wells PE >4 or D dimer positive, then do CTPA (gold standard) • If CTPA contraindicated (renal impairment or contrast allergy or pregnant) then do VQ scan instead • If CTPA or VQ is negative, stop DOAC • If CTPA or VQ is positive, continue DOAC • If CTPA or VQ negative, but DVT suspected, do leg US doppler Management of PE • Immediate o A to E and stabilisation o Oxygen o Analgesia (morphine if severe) o Conservative o TEDS o Advice on future deterrence: hydration, exercise, smoking cessation, OCP cessation
