PULMONARY EMBOLISM

DEFINITION

Pulmonary embolism is the blockage of pulmonary arteries by thrombus, fat or air emboli and tumour tissue.

It is the most common complication in hospitalized patients.

An embolus is a clot or plug that is carried by the bloodstream from its point of origin to a smaller blood vessel, where it obstructs circulation.

ETIOLOGY AND RISK FACTORS

Virtually all pulmonary embolisms develop from thrombi (clots), most of which originates in the deep calf, femoral, popliteal, or iliac veins.

Other sources of emboli include tumours, fat, air, bone marrow, amniotic fluid, septic thrombi, and vegetations on heart valves that develop with endocarditis.

Major operations, especially hip, knee, abdominal and extensive pelvic procedures predispose the client to thrombus formation because of reduced flow of blood through pelvis.

Traveling in cramped quarters for a long time or sitting for long periods is also associated with stasis and clotting of blood.

CLINICAL FEATURES

Severity of clinical manifestations of pulmonary embolism depends on the size of the emboli and the size and number of blood vessels occluded. Most common manifestations are

Anxiety

Sudden onset of unexplained dyspnea

Tachypnea or Tachycardia

Cough

Pleuritic chest pain

Hemoptysis

Crackles

DIAGNOSTIC TESTS

IMAGING STUDIES

CXR

V/Q Scans

Spiral Chest CT

Pulmonary Angiography

Echocardiography

LABORATORY ANALYSIS

CBC, ESR

D-Dimer

ABG’S

ANCILLARY TESTING

ECG

Pulse Oximetry

COMPLICATIONS OF PULMONARY EMBOLISM

Sudden cardiac death

Obstructive shock

Pulseless electrical activity

Atrial or ventricular arrhythmias

Secondary pulmonary arterial hypertension

Cor pulmonale

Severe hypoxemia

Right-to-left intracardiac shunt

Lung infarction

Pleural effusion

Paradoxical embolism

Heparin-induced thrombocytopenia

Thrombophlebitis

MEDICAL MANAGEMENT – PULMONARY EMBOLISM

Emergency Management

Nasal oxygen

IV infusion for medication

Perfusion scan

ABGs and ECG

Small dose of Morphine

Intubation and mechanical ventilation

MEDICATIONS

Anticoagulants are prescribed when pulmonary embolism is diagnosed or suspected

Heparin

Warfarin

Rivaroxaban

Fondaparinux

Most commonly the patient will take an anticoagulant for at least 3 months after pulmonary embolism to reduce the risk of having another blood clot.

SURGERY

Surgical management of acute pulmonary embolism (pulmonary thrombectomy) is uncommon and has largely been abandoned because of poor long term outcomes. However, recently, it came back again with the revision of the surgical technique and is thought to benefit certain people.

Chronic pulmonary embolism leading to pulmonary hypertension (known as chronic thromboembolic hypertension) is treated with a surgical procedure known as a pulmonary thromboendarterectomy.

NURSING MANAGEMENT OF PULMONARY EMBOLISM

Evaluation of risk factors on admission and during hospital stay

Encourage maximal mobility, range of motion and ambulation when appropriate or leg compression devices if on bed rest.

Administer anticoagulant medication – heparin continuous IV drip until Coumadin started and PT/INR is therapeutic

Monitor liver function when patients receive anticoagulants

Monitor Lab for anticoagulants effectiveness (Heparin-PTT q 6 hours till in range then q day)

Assess for symptoms of bleeding and heparin-induced thrombocytopenia (HIT)

IVC Filter – vena cava filter

Pulmonary Embolism PDF

 

Pulmonary Embolism

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