Pulmo. PE

Question 1

PE. Location? 10 min

Answer 1

ED —> inpatient or ICU

Question 2

PE. Chief complaint?

Answer 2

SOB + painful calf

Hx long flight

Question 3

PE. exam? 5 + 1

Answer 3

General
Chest - chief, rales in lungs
Heart - sinus tachy, accenuated pulmonic S2
Abdomen - tiesiog ,,important”
HEENT/NECK - could be a source of patients symptoms (wtf?)

zymejau extremities (del DVT) - nu tai nx nebuvo

Question 4

PE. Orders?

Answer 4

STABILIZING!

SOB –> reikia Pulse oximetry
Blood pressure monitor ir Cardiac monitor – prie gydymo dalies buvo

Question 5

PE. Labs? 2 general

Answer 5

CBC
BMP

Question 6

PE. heart Labs/instrum? 2+1

Answer 6

Troponins - to rule out MI
ECG - RV distension due to PE, MI.

proBNP - optional
as cardioecho dariau - nebuvo

Question 7

PE. chest labs? 2

Answer 7

ABG!!
D-dirmer - sensitive, but non-specific test for PE. It is best used in ruling out PE in patients with low or intermediate probability of PE (based on wells)

Question 8

PE. INSTRUMENTAL? 3

Answer 8

Chest xray - patient has SOB, need xray to rule out infection or other pahologic process

TADA
Chest CT spiral WITH CONTRAST!!!!!!!! – will clinch Dx.

DOPLER OF LOWER EXTREMITY, venous – had symptoms of DVT.

Question 9

PE. Mx? 3

Answer 9

1. Iv access
2. Cardiac monitor - during anticoagulation (arba prie stabilizing)
3. Medications - ANTICOAGULATION

Consult pumonary medicine - optional, nes PE typically handed by internal medicine

Question 10

PE. Medications - ANTICOAGULATION. Monotherapy?

Answer 10

Rivaroxaban and apixaban can be given as monotherapy
dont give them if kidney function impaired

Question 11

PE. Medications - ANTICOAGULATION. What if you give heparin?

Answer 11

Jeigu uzsakai HEPARIN–> butina uzsakyt WARFARIN

Question 12

PE. Medications - ANTICOAGULATION. What if you give LMWH?

Answer 12

Galima duoti ji viena, tiesiog taip ir vadinasi Low molecular weight heparin (eg enoxaparin).

Question 13

PE. Preventive care? specific 1

Answer 13

Advise patient, side effect of medications - del antikoaguliantu apie bleeding risk

Question 14

PE. Preventive care? Nonspecific 2

Answer 14

Tdap
Advice, exercise (buvo obesity)