Clot or Not Clot
This triad describes the three main factors contributing to thrombosis: endothelial injury, stasis, and hypercoagulability.
What is Virchow's Triad?
*case correlation* which of these is the main cause in our case?
The classic triad of symptoms for pulmonary embolism includes pleuritic chest pain, hemoptysis, and this common but nonspecific symptom.
What is dyspnea (shortness of breath)?
Alteplase promotes the conversion of this following enzyme
This non-invasive imaging test, often used to evaluate suspected DVT, utilizes high-frequency sound waves to visualize blood flow and detect clot formation.
What is doppler ultrasonography?
This condition, characterized by long-term complications such as chronic dyspnea and reduced exercise tolerance, can develop following a massive pulmonary embolism
What is chronic thromboembolic pulmonary hypertension (CTEPH)?
In deep vein thrombosis, a clot most commonly originates in these lower extremity veins before potentially embolizing to the lungs. Must give at least 2 of the 4)
What are the femoral, popliteal, iliac, or deep calf veins
This physical exam sign, characterized by calf pain with dorsiflexion of the foot, was historically associated with DVT but is neither sensitive nor specific.
What is Homan's sign?
to the SLIDES
Alteplase works best w/n 4.5hrs for TIA/CVA, w/n 12hrs for STEMI, and w/n this range of hours for PE
What is no strict time limit -->
must ask questions: is the pt hemodynamically stable? yes --> give when the risk of bleeding is diminished. IF NO, give ASAP
In suspected PE, this imaging modality provides a high-resolution 3D view of the pulmonary vasculature and can identify clot occlusions using contrast dye (be specific).
What is CT pulmonary angiography (CTPA)?
A hypercoagulable state, like this genetic condition, significantly increases the risk of developing DVT and PE due to defective clotting regulation.
What is Factor V Leiden mutation?
TO THE SLIDES
Pulmonary embolism leads to this type of failure due to increased right ventricular afterload and impaired left ventricular filling.
What is right heart failure?
A massive pulmonary embolism can cause this life-threatening hemodynamic complication.
What is obstructive shock?
Unlike heparin, which has a rapid onset, warfarin requires bridging with a parenteral anticoagulant due to the initial depletion of this natural anticoagulant.
What is protein C?
This scoring system, often used to help assess the probability of a PE, considers factors like recent surgery, history of DVT, and clinical signs of deep vein thrombosis.
What is the Wells score?
TO THE SLIDES
This common risk factor for both DVT and PE, particularly in hospitalized patients.
What is prolonged immobility?
This is case correlated -->must know
In a large PE, hypoxia occurs due to a mismatch of these two processes, which describe airflow and blood flow in the lungs.
What are ventilation and perfusion (V/Q mismatch)
TO THE SLIDES
Some cases of PE are "silent" or have minimal symptoms, but this common finding on physical exam—often associated with hypoxemia—can be an important clue.
What is tachycardia?
This direct oral anticoagulant (DOAC) inhibits both thrombin and factor Xa, offering an advantage of not requiring bridging therapy for PE/DVT treatment.
What is dabigatran?
A 28-year-old pregnant woman at 28 weeks gestation presents to the emergency department with complaints of shortness of breath, right lower leg swelling, and sharp chest pain that started 2 days ago. The chest pain is worse with deep breaths and associated with tachypnea and mild cough. She denies fever, hemoptysis, or recent trauma.
She has a history of mild swelling in the lower extremities, which has worsened over the past few days. She is currently in her third trimester, and has not had any recent immobility, surgery, or long travel.
On physical examination, she is tachycardic (HR 105) and tachypneic (RR 22), with mild hypoxia (SpO2 94%) on room air. Her right calf is swollen, tender, and warm to the touch.
This is the best next diagnostic work up for this pt to r/o or r/i PE.
CT pulm angiography -->
NOTE!
if massive PE is suspected, get the CT there are protocols to lower radiation dose. PROs outweigh the CONs
D-dimer is unreliable in pregnancy, so is V/Q
The presence of this chronic condition, characterized by obesity, diabetes, and hypertension, is considered a significant risk factor for developing both DVT and PE
What is metabolic syndrome?
This is the enzyme involved in the breakdown of fibrin that leads to increase D-dimer in PE/DVT
A PE that causes right ventricular strain can lead to this physical exam finding
What is jugular venous distension (JVD)?
PT experiences a massive hemmorhage post heparin administration --> this agent must be considered for administration to prevent massive hemmorhagic shock.
What is protamine sulfate?
This is the plane that CTs are taken from if you suspect PE.
Funky answer
The axial plane is taken, where multiple slices are done to create a coronal and sagittal view of the thorax
This rare but serious complication of DVT occurs when the clot extends into the inferior vena cava, causing severe swelling and possible damage to the renal veins.
What is phlegmasia cerulea dolens?