Condition Info - BotMed Application

ConditionName

Pulmonary embolism (PE)

ConditionDescription

Symptoms

Sudden onset; Dyspnea;
SOB with clear lungs on exam and normal chest xRay;
Chest pain increases with deep breathing;
Cough, Hemoptysis (not always);
If DVT is present – leg pain;
Pleuritic chest pain from lung infarction;
Feeling that something terrible happen to them;
Fever;
Big clot -> hypotension;
Altered mental status;

PhysicalFindings

Pleural friction rub; Hypoxia; (-) JVP;
Very specific: Tachypnea; Tachycardia; Decrease O2 saturation;
Heart rate (> 100);

ClinicalTests

Specific test:
Spiral CT – best initial test; 
V/Q scan – old test if test is normal – no PE;

D-dimer can help to r/o DVT and PE, not specific;

CT angiography; 
ABG: hypoxia and resp. alkalosis;
Chest xRay – often normal;
ECG

ECG: Sinus tachycardia;
Most common abnormality: ST-T wave changes;

xRay may show atelectasis, pleural infusion or “Hampton’s hump”

5% will show right axis deviation, RV hypertrophy or RBBB

Most accurate test: angiography (0.5% mortality) almost never used

Wells risk score :
Clinical signs and symptoms of DVT;
PE is #1 diagnosis OR equally likely;
Heart rate > 100;
Immobilization at least 3 days OR surgery in the previous 4 weeks;
Previous, objectively diagnosed PE or DVT;
Hemoptysis;
Malignancy w/ treatment within 6 months or palliative pneumo

RiskFactors

History DVT; Sometimes upper extremity DVT; Superficial femoral vein clot 
Recent surgery; 
Pregnancy;
Cancer – age appropriate screening! 
Immobility – economy class trailers 
Recent surgery
OCP
High coagulation status: nephrotic syndrome (they loose a lot of albumin)
Inherited thrombophilia
-	Factor V Leiden (can’t activate protein C)
Stasis of blood flow
Endothelial injury
Obesity
Fractures
Severe burns

IsRedFlag

IsNPLEX

Consequence

ProgressionFromCondition

TreatmentOptions

Start O2;
IV fluids or pressor;
surgery;

PharmOptions

Heparin: best initial therapy;
Oral warfarin should be started with heparin;

Never use ASA!!!

WebLink

https://www.merckmanuals.com/en-ca/professional/pulmonary-disorders/pulmonary-embolism-pe/pulmonary-embolism-pe