Peri operative care

  1. Give 5 ways of preventing a post op PE ?
    • TEDS (thromboembolic deterrent stockings)
    • Pneumatic calf compression
    • LMW Heparin at prophylactic dose
    • stop HRT, pill pre op
    • ask about FH of thromboembolism and consider for inv for thrombophilia
  2. Give 5 symptoms of PE?
    • breathlessness
    • pleuritic chest pain
    • haemoptysis
    • syncope
    • dizziness
  3. Give 8 signs of PE
    • tachycardia
    • tachypnoea
    • pyrexia
    • cyanosis
    • raised JVP
    • pleural effusion
    • pleural rub
    • hypotension
  4. what signs of a cause of PE would you look for?
    • DVT - swollen leg
    • scar from recent surgery
  5. what are the main RF for PE? in categories
    • surgery: major abdo, pelvis, hip or knee replacement
    • obstetrics: late pregnancy, post partum, C section, pill, HRT
    • Lower limb problems: fractures, varicose veins (valves not working)
    • Malignancy
    • Prolonged bed rest, reduced mobility
    • Previous PE
  6. What is the treatment for a PE?
    • Anticoagulation:
    • 1. LMW heparin (dalteparin SC)
    • 2. start oral warfarin 10mg
    • stop heparin when INR is >2
    • continue warfarin for a minimum of 3 months, aiming for INR: 2-3
  7. what would you consider if pt develops emboli despite adequate anticoagulation?
    vena caval filter
  8. which test may help EXCLUDE a PE?
    D dimer test - do in pts with a low clinical probability of PE, to exclude it. NB it cannot prove there is a PE though
  9. What are the signs of a PE on CXR?
    • often normal!
    • decreased vascular markings
    • small pleural effusion
    • wedge shaped area of infarction
    • atelectasis
  10. what are the 2 most sensitive and specific tests for diagnosing PE?
    • VQ perfusion scan
    • CT pulmonary angiography
  11. what are the signs on ECG of a PE?
    • tachycardia
    • RAD
    • RBBB
    • RV strain pattern in V1 to V3: dominant R wave, inverted T wave, ST depression
    • rare: SI, QIII, TIII: deep S waves in I, pathological Q waves in III, inverted T waves in III
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Peri operative care
periop care