1. What is a embolus comprised of?
    • A thrombus, fat, mass of bacteria or a foreign body.
  2. What is an embolus?
    Object circulating in the blood that occludes a vessel (pulmonary vasculature).
  3. What is a thrombus?
    A blood clot formed within a blood vessel and remaining attached to its place of origin.
  4. Risk factors for P.E.
    • Prolonged immobilization (3-4 hrs) venous stasis (trucker)
    • Vacation (flight)
    • Birth control pills
    • Hypercoaguable states due to anticoagulant defeciancies (protein C & S)
    • Malignancy (breast, lung, colon) releases procoagulant hormones.
    • Autoantibodies (lupas anticoagulant)
  5. Symptoms of PE
    SOB, diaphoretic, tachypnic, tachycardia, hypotension
  6. Tests to diagnose P.E.
    • Gold Standard: Pulmonary angiogram with IV contrast.
    • CT chest with IV contrast (easiest test), if pt has renal failure, or allergy then V/Q.
    • V/Q scan
    • D-dimer
  7. What is a D-dimer & it's reliability.
    • Fibrinogen>thrombin>(fibrin mesh)>factor XIII>croslinked fiber mesh (d-dimer)>plasmin.
    • The d-dimer is towards the end of the clotting cascade making the D-dimer specific for a clot.
    • Has poor specificity becuase other inflammatory conditons other than PE can have elevations.
    • Test is only reliable if pt has no other comorbidities.
    • Confused: D-dimer vs.BNP (see flashcard on BNP to not get these confused).
    • Remember D-dimer: dime (clot) stuck in the lungs.
  8. When do you use a D-dimer?
    • DVT
    • PE
    • DIC
  9. False positive of D-Dimer
    • (dont need to know extra)
    • False positive can be due to: liver disease, high rheumatoid factor, inflammation,
    • malignancy,trauma, pregnancy, recent surgery as well as advanced age
  10. What is BNP?
    • B-type natriuretic peptide (BNP) is a cardiac neurohormone that is released from the ventricles in response to volume or pressure overload, may differentiate congestive heart failure (CHF) from other
    • causes of dyspnea.
  11. What does CT stand for?
    computed tomography (to-MOG-rah-fee)
  12. What is a V/Q scan?
    • A lung ventilation/perfusion scan shows how well oxygen and blood are flowing to all areas of the lungs.
    • The ventilation scan shows where air flows in your lungs by inhaling a small amount of radioisotope gas.
    • The perfusion scan shows where blood flows in your lungs, radioisotopes are injected into a vein in your arm.
    • Radioisotopes (a low-risk radioactive substance) create images of air and blood flow patterns in your lungs.
  13. Treatment of P.E.
    • Antigoagulants x 3 months
    • Heparin drip: (unfractionated) IV
    • LMWH (low molecular weight): Lovenox BID SQ
    • Anti-thrombin III binder: fondaparinux
    • Recurrent episodes require IVC filter greefield filter
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