Pulmonary Embolism

What are risk factors for PE?

• DVT, obesity, surgery, smoking, immobility, pregnancy, age, hormone therapy

What is pleuritic chest pain?

What condition is this associated with?

• sharp, stabbing or burning chest pain that worsens with coughing, breathing or sneezing (inflammation of the pleura)

• PE, autoimmune conditions, pneumonia etc.

What is haemoptysis?

• coughing up blood

If patient is having PE, what might their breathing rate be?

• tachypnoeic

• >16breaths per min

What are signs of PE?

• pleuritic chest pain

• dyspnoea

• haemoptysis

• syncope or pre-syncope (fainting or light headedness)

• tachypnoeic >16 breath/min

What are symptoms of PE?

• DVT features (swelling of one leg)

• cough

• hypotension (sys <90)

• tachycardia >100bpm

• tachypnoeic >16 breath/min

• hypoxia

• increased body temp

What tests are used to diagnose PE?

• physical exam

• D-dimer test - protein fragment present in blood after clot degraded by fibirnolysis

• CTPA - computerised topography pulmonary angiography

• ventilation perfusion scan (V/Q scan - examines airflow and blood flow in lungs)

What does D-dimer test check for?

• D-dimer (a small protein fragment) present in the blood after a blood clot is degraded by fibrinoylsis

Can chest x ray diagnose PE?

What about ECG?

• no but helps with ruling out differential diagnosis

• same as above

What are medical procedure for treatment of PE?

• surgical embolectomy

• venous filter placement

What are pharmacological treatments for PE?

• oxygen

• thrombolysis (alteplase)

• anticoagulation (LMWH - enoxaparin, followed by DOAC/warfarin)

How long are PE patients on enoxaparin (LMWH) before switching to oral DOAC

• at least 5 days

How often is warfarin monitoring?

• weekly

What can dabigatran increase risk of?

• GI S/E and MI