Peri operative care
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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
Give 5 symptoms of PE?
- pleuritic chest pain
Give 8 signs of PE
- raised JVP
- pleural effusion
- pleural rub
what signs of a cause of PE would you look for?
- DVT - swollen leg
- scar from recent surgery
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)
- Prolonged bed rest, reduced mobility
- Previous PE
What is the treatment for a PE?
- 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
what would you consider if pt develops emboli despite adequate anticoagulation?
vena caval filter
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
What are the signs of a PE on CXR?
- often normal!
- decreased vascular markings
- small pleural effusion
- wedge shaped area of infarction
what are the 2 most sensitive and specific tests for diagnosing PE?
- VQ perfusion scan
- CT pulmonary angiography
what are the signs on ECG of a PE?
- 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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