Term
| What does a "Hampton's hump" on CXR indicate? |
|
Definition
|
|
Term
| What are some sign and symptoms of PE with infarction? |
|
Definition
Pleuritic chest pain over infarcted area
CXR shows consolidation over infarcted area with pleural effusion |
|
|
Term
| How does a non-infarcted PE present? |
|
Definition
| Many times presents with no chest pain and no SOB, variable or vague complaints including rest of exertional dyspnea |
|
|
Term
| What does dyspnea at rest almost always imply? |
|
Definition
| implies Vent/Perfusion inequality |
|
|
Term
| What pulse ox reading is characteristic of a PE? |
|
Definition
| < 95% with no other explanation |
|
|
Term
|
Definition
Age less than 50
Pulse rate less than 100 beats/min
Oxygen saturation greater than 94%
No hormone use [OC, Testosterone (Workout Hormones), Early hysterectomy]
No hemoptysis
No unilateral leg swelling
leg pain/cramping/”injury”
No recent major surgery or trauma
Recent hospitalizations (bed ridden)
No prior pulmonary embolism or DVT |
|
|
Term
| What is the most common EKG result from obstructive pulmonary embolism? |
|
Definition
|
|
Term
| If PE obstructs greater than 50% of the pulmonary vasculature, what effects can occur in the heart? |
|
Definition
| acute increase in RV pressure which can lead to dilation, weakness and hypotension |
|
|
Term
| What are the components of Virchow's Triad? |
|
Definition
Trauma,
Stasis,
hypercoagulable state |
|
|
Term
| What are some risk factors of PE? |
|
Definition
Smoking
BC Pills
Post-partum pregnancy
Obesity
HTN
Hormone Replacement
Cancer
CHF |
|
|
Term
| What are the expected signs and symptoms of a PE? |
|
Definition
Pleuritic Chest PAin
Dyspnea
Hemoptysis
Syncope
Tachycardia >100BPM
Tachypnea
Pulse Ox <95%
Unilateral limb edema |
|
|
Term
| What are some atypical symptoms associated with PE? |
|
Definition
Weakness
Dyspnea
Syncope
Non-specific Malaise |
|
|
Term
| What is the typical presentation of a PE? |
|
Definition
| 2-3 days of shortness of breath now bad enough to see medical treatment |
|
|
Term
| Is substernal chest pain typical of a PE? |
|
Definition
| No, that is more of a cardiac complaint |
|
|
Term
| What can a PE on CXR look like? |
|
Definition
| can look like lobar pneumonia |
|
|
Term
| What labs should be done if PE is suspected? |
|
Definition
CBC w/differential
D-dimer (will typically be elevated wiPE)
CMP/BMP (Renal Function)
Urine BHCG
EKG
Cardiac Enzymes
ABG |
|
|
Term
| What is a rare sign of a very large pulmonary embolism? |
|
Definition
|
|
Term
| What is the best test to diagnose a PE? |
|
Definition
|
|
Term
| What test assesses the Fibrin degradation product found in the blood after a blood clot is degraded by fibrinolysis? In what conditions is it falsely elevated? |
|
Definition
| D-dimer; pregnancy, pts on warfarin, |
|
|
Term
| Which is safer in pregnancy for diagnosing a PE, VQ scan or CT Angiography? |
|
Definition
|
|
Term
| What are any obstructions in a VQ scan viewed as? |
|
Definition
| Viewed as perfusion defects |
|
|
Term
| What must you give patients STAT if PE is suspected? Before giving this, what test should be done, why? |
|
Definition
Anticoagulant (Start with unfractionated heparin IV bolus than infusion, than switch to cumadin after 2-3 days)
Hemoccult to r/o rectal bleed |
|
|
Term
| Besides being a clot-buster, what properties does heparin have? |
|
Definition
| Anti-inflammatory properties which helps with pulmonary vasculitis caused by a PE |
|
|
Term
| What is a risky thrombolytic used in severe PE cases? |
|
Definition
|
|
Term
| What are some FDA approved thrombolytics used for PE? |
|
Definition
Streptokinase
Urokinase(Abbokinase) |
|
|
Term
| What Bundle Branch Block is a common complication of a PE? |
|
Definition
|
|
Term
| Under which conditions is surgery recommended for PE? |
|
Definition
patient with a “free” or “floating” embolus in the right side of the heart
patient with very severe refractory hypotension
patients who have a large embolus and cannot undergo fibrinolysis |
|
|
Term
| What factors can be affected with genetic antithrombolytic deficiency? |
|
Definition
antithrombin III
protein C
protein S |
|
|
Term
| What test can be run to detect lower extremity thrombi? |
|
Definition
|
|
Term
| Which veins are the deep calf veins? |
|
Definition
anterior tibial,
posterior tibial,
peroneal veins |
|
|
Term
| What are some signs and symptoms of a DVT? |
|
Definition
calf cramp,
soreness,
fullness,
Swelling,
edema,
erythema,
warmth,
unilaterally,
palpable venous cord |
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