8. Pulmonary Embolism Flashcards

1
Q

A pulmonary embolism (PE) is a ___

A

partial or complete obstruction of the pulmonary capillary bed by a blood clot or another substance such as fat, air, amniotic fluid, or a foreign material, with a disruption of blood flow to an area of the lung.

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2
Q

Massive PE

A

> 50% occlusion

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3
Q

Submassive PE

A

< 50% occlusion

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4
Q

80 - 90% result from ___

A

DVT

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5
Q

Although a pulmonary embolism may be the result of a variety of causes, ____

A

venous thromboembolism (VTE) is the primary cause. VTE and a fat embolism are the 2 types of embolism that are most likely to be covered on exam. Refer to Table 4-12 for the risk factors for VTE and Figure 4-13 for the pathophysiology of PE.

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6
Q

Strong Risk factors for VTE

A

-Fracture (hip or leg)
-Hip or knee replacement
-Major trauma
-Spinal Cord injury

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7
Q

Moderate Risk Factors for VTE

A

-Arthroscopic knee surgery
-Central venous lines
-Chemotherapy
-HF or Resp Failure
-Hormone Replacement Therapy
-Malignancy
-Oral contraceptives
-Stroke
-Pregnancy, postpartum
-Previous VTE

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8
Q

Weak Risk Factors for VTE

A

-Bed rest > 3 days
-Prolonged sitting
-Increasing age
-Laparoscopic surgery
-Obesity
-Pregnancy, antepartum
-Varicose veins

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9
Q

Pathophys of PE

A

Clot in Pulmonary Vasculature
–>decreased perfusion of blood
–>Local release of biochemical substances
–>Local lung constriction
–>Atelectasis
–>Pulmonary infarction (not fatal)
or

Clot in Pulmonary Vasculature
–>decreased perfusion of blood
–>V/Q mismatch
–>decreased pulmonary perfusion
–>If pulmonary perfusion < 50%
–>Pulmonary artery pressure increases
–>Right Ventricle Failure
–> decreased cardiac output, BP
(may be fatal)

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10
Q

Signs and symptoms of most PEs

A

-Dyspnea, Tachypnea
-tachycardia, chest pain
-Right-sided S3 or S4 heart sounds
-Anxiety, apprehension
-Cough, hemoptysis, crackles
-syncope
-Petechiae (fat emboli)
-low-grade fever
-respiratory alkalosis
-positive D-dimer

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11
Q

Signs and symptoms of Massive PEs

A

-Hypoxemia
-Hypotension
-EKG changes - RBBB, Right axis deviation on the ECG,
tall peaked P-waves in lead II, RV strain
pattern, ST elevation in V1 & V2
-Cardiopulmonary arrest – PEA
-Elevated BNP (due to right ventricular wall stress)

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12
Q

Types of PE

A

*Venous thromboembolism - DVT
*Fat emboli - long bone, pelvic fx
-Air emboli - surgery, IV lines
-Catheter embolization
-RA/LA or RV embolus - AFib/flutter (left atrial leading to
stroke is more common)
-Amnioti fluid embolism (rare) - amniocentesis, abruptio
placenta, or abortion
-Tumor emboli - malignancy causes an increase in
thrombin
-Septic emboli - bacterial/viral

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13
Q

Diagnosis of PE

A

-Pulmonary angiography - GOLD STANDARD
-V/Q Scan: “high” probability , “low” probability, not
definitive
-High-speed CT scan
-D-dimer: good rule-out test: if positive, it means that a clot is present in the body; therefore if symptoms ARE due to PE, expect a D-dimer to be positive
-Venous Doppler (helps with source)

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14
Q

Note: ~2/3 of PE never get

A

diagnosed!

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15
Q
  • A PE will increase
A

alveolar dead space **

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16
Q

Prevention of PEs (mechanical)

A

-Graduated compression stockings (GCS) and/or
-Intermittent pneumatic compression (IPC)
-Use continuously except while ambulating!

17
Q

Prevention of PEs (pharmacological)

A

-Low-molecular-weight heparin (LMWH): enoxaparin (Lovenox) DAILY

-Low-dose unfractionated heparin: t.i.d.

-rivaroxaban (Xarelto): DAILY

-apixaban (Eliquis): b.i.d.

18
Q

Treatment of PE

A

-Maintain adequate airway, ventilation, and oxygenation
-Fluids!
-Anticoagulation
-Heparin (80 units/kg IVP and then 18 units/kg/hr
drip)
-Low-molecular-weight heparin (1 mg/kg q12 hrs)
-Coumadin ON THE FIRST TREATMENT DAY if able
-The pt may require long-term anticoagulation

-Fibrinolytic therapy: FOR ALL PTS WITH HEMODYNAMIC COMPROMISE WITH A LOW RISK FOR BLEEDING.

-maintain cardiac output (inotropes, fluids)
-analgesics for a pt who experiences pain

(note: you will not need to know drug doses for exam)