28- Pulmonary embolism.

what is PE

• due to thromboembolism- mainly from DVT

• usually silent- dual blood supply of lung

• can cause pulmonary infarction if large enough

what is the etiology of PE

• DVT most common!

  • prolonged bed rest, surgery, trauma, hypercoagulability, contraceptives, congestive HF

what is the pathophysiology of PE

• thrombosis usually from DVT

  • ventilation/ perfusion mismatch in scintigraphy

  • occlusion in PA on CTA

what are the symptoms of PE

• stabbing chest pain, dyspnea, syncope

• tachycardia, tachypnea, hypotension, hypoxia,

what can be seen on physical exam in PE

• A+B: Tachypnea, dyspnea-

  • most common symptom, present
    in 90% of patients, diaphoresis, hypoxia-hyperkapnia

• C: Tachycardia, hypotension, cardiovascular collapse, right
  ventricular overload on Echo

• D: Anxiety, pain

• E: low grade fever

how do you do Dx PE

• D Dimer in low risk patient to rule out PE

• echo (elevated PAP, D-sign, preserved EF),

• chest CT-angio!

what are the signs of PE on an ECG

• sinus tachycardia

• Classic S1,Q3,T3 finding is seen in less than 30%

what are the criteria's used for PE

• Wells criteria

• Geneva prediction rule

what is the Wells criteria for PE

• Clinical Signs and Symptoms of DVT?- Yes +3

• PE is #1 Diagnosis, or Equally Likely?- Yes +3

• Heart Rate > 100? Yes +1.5

• Immobilization at least 3 days, or Surgery in the Previous 4 weks?Yes +1.5

• Previous, objectively Dx PE or DVT? Yes + 1.5

• Hemoptysis? Yes +1

• Malignancy w Rx w/in 6 mo, or palliative? Yes +1

• <2=low risk, 2.5-6=moderate risk, >6=high risk

what is the risk management for acute PE

what is the management of the risk groups of acute PE

what is the pharmacological treatment of PE