A simple and concise slide about pulmonary embolism

1. Pulmonary Embolism

2. Causes
 Venous thrombus in the pelvis or legs
 Right ventricular thrombus (post MI)
 Emboli
 Septic:Right sided endocarditis
 Fat
 Air
 Amniotic fluid
 Neoplastic cells
 Parasites

3. Risk factors
 Recent surgery
 Abdominal/pelvic replacement
 Hip/knee replacement
 Thrombophilia
 Leg fracture
 Prolonged bed rest/reduced mobility
 Malignancy
 Pregnancy/postpartum ;pill/HRT
 Previous PE

4. Clinical features
 Symptoms
 Dyspnea
 Pleuritic chest pain
 Haemoptysis
 Dizziness
 Syncope

5. Clinical features
 Signs
 General inspection
 Pyrexia
 Cyanosis
 Tachycardia
 Hypotension
 Inspection
 Tachypnea
 Raised JVP
 Palpation
 Percussion
 Auscultation
 Pleural rub

6. Tests
 FBC
 U&E
 Baseline clotting
 D-dimers
 ABG
 CXR:oligaemia of affected segment,dilated pulmonary artery,linear
atelectasis,small pleural effusion,wedge shaped opacities,cavitation
 ECG:tachycardia,RBBB,right ventricular strain(inverted t in V1 to V4),classical
SI,QIII,TIII

7. CXR

9. Treatment
 Anticoagulate with LMW heparin
 Start warfarin
 Stop heparin when INR >2
 Continue warfarin for a minimum of 3 months (aim INR 2-3)
 Thrombolysis:Alteplase 50mg bolus for massive pulmonary embolism
 Vena cava filter for patients who develop emboli despite adequate anticoagulation

10. Prevention
 Heparin to all immobile patients
 Compression stockings
 Encourage early immobilization
 Stop HRT and Pill pre-op (if reliable with another form of contraception