20 PE - Boards and Beyond

  • femoral vein: thigh
  • popliteal vein: behind knee

  • edema from poor venous outflow

Symptoms

  • worse with deep breath
  • sudden death: so much obstruction of blood flow that dies from shock

Diagnosis

  • CT contrast
  • thrombus in pulmonary artery

  • large PE crossing bifurcation
  • saddle emboli
  • pt likely to be in shock

  • classic EKG
  • deep S wave in lead 1, Q wave and inverted T wave in lead III
  • pseudo RBBB in V1, lower right: normal
  • sign of right heart strain: massive PE

  • in clinical practice and ER

  • blood clots present and broken down by coagulation system: raise D-dimer
  • for ruling out DVT/PE with low Wells score

  • inhale nuclear tracer: left
  • inject nuclear tracer: right
  • see difference in V/Q

Treatment

  • similar causes and treatment to PE
  • together aka VTE

Fat Embolism

  • fat in bone marrow leak out
  • triad of symptoms in lung, CNS, skin

  • lung: respiratory failure
  • looks like ARDS
  • pt after trauma present with dyspnea, confusion, petechiae

Amnionic Fluid Embolism

  • women shortly after delivering baby develops symptoms
  • biopsy shows fetal squamous and keratin debrid

  • seizure can be seen in phase 1 or 2