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Cardiopulmonary Science > ch 20 pulmonary embolism > Flashcards

ch 20 pulmonary embolism Flashcards

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1
Q

definition of pulmonary embolism

A

obstruction of the pulmonary artery or one of its branches

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2
Q

what is an embolus

A

clot that travels through the bloodstream from its vessel of origin to lodge in smaller vessel obstructing flow

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3
Q

possible sources

A

fat, air, bone marrow, tumor fragments, blood clots

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4
Q

what is the most common source of emboli

A

blood clot

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5
Q

where does it usually orgiinate

A

in deep veins of leg or pelvic area

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6
Q

where does the emboli travel to

A

back to heart through the venous system and lodges in pulmonary artery

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7
Q

why does a clot usually form

A

stagnation of blood flow, prolonged bed rest, immobility from trauma, surgery, paralysis, or pain

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8
Q

examples of predisposing factors

A 
long travel
CHF
varicose veins
thrombophlebitis
traumatic injury
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9
Q

in terms of traumatic injury what should be looked at carefuilly

A

bone fractures from pelvis and long bones of lower extremities and extensive injury to soft tissure

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10
Q

hyper coagulation disorders that cause embolism

A

oral contracetpives, polycythemia, multiple myeloma

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11
Q

what does the blockage result in

A

dead space ventilation (ventilation w/o perfusion)

which causes a high v/q mismatch

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12
Q

what causes high v/q mismatch

A

dead space

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13
Q

what causes low v/q mismatch

A

shunt

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14
Q

what is the initial v/q ratio response and what does it lead to

A

a high ratio is initial and it leads to low v/q mismatch

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15
Q

what causes the change from high to low v/q mismacth

A

activation of serotonin, histamine, and prostaglandin

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16
Q

what is caused by the release of serotonin, histamine, and prostaglandin

A

alveolar atelectasis, alveolar consolidation, bronchoconstriciton, shunting

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17
Q

what causes approx 10% of cases

A

infarction

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18
Q

what dictates the pathophysiology

A

size of thromboembolism

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19
Q

what determines the impact on the cardiovascular system

A

size and number of pulmonary embolism

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20
Q

where is the reduction of cardiac output seen

A

on the systemic side

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21
Q

what heart effects are seen in pulmonary side

A

pulmonary hypertension and increased right ventricular workload

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22
Q

what heart effects are seen in systemic side

A

systemic hypotension from decreased blood flow entering left ventricle

23
Q

how does the body attempt to compensate for the systemic side

A

increased heart reate

24
Q

what are the most common symptoms of pulmonary embolism

A 
dyspnea
tachypnea
pleuritic c'est pain
cough
tachycardia
hypotension
25
Q

additional findings include

A

abnormal heart sounds
distended neck veins
swollen and tender liver
right ventricular heave or lift and distention

26
Q

chest ausculation

A

inspiratory crackles and wheezes

pleural friction rub

27
Q

when is pleural friction rub most common

A

when pulmonary infarction involves the pleura

28
Q

what is seen in mild to moderate pulmonary emboli ABG

A

acute alveolar hyperventilation with hypoxemia

29
Q

what is seen in severe pulmonary embolism with infarction

A

acute ventilatory failure with hypoxemia

30
Q

what happens when tissue hypoxia is severe enough to produce lactic acid

A

the pH and HCO3 will be lower than expected for a particular paco2

31
Q

increased or decreases shunt fraction qs/qt

A

increased

32
Q

i/d oxygen delivery

A

decreased

33
Q

i/d oxygen extraction ratio

A

increased

34
Q

what is normal oxygen extraction ratio

A

normal

35
Q

i/d svo2

A

decreased

36
Q

i/d central venous pressure (cvp)

A

increased

37
Q

i/d pulmonary artery pressure (pap)

A

increased

38
Q

what is normal pulmonary artery pressure

A

no greater than 25/10 mmhg

39
Q

what is normal mean pulmonary artery pressure

A

15 mmhg

40
Q

what is normal mean pulmonary artery pressure for patients with the embolism

A

excess of 20mmhg

41
Q

what are the 3 major mechanisms that contribute to pulmonary hypertension

A
  1. decreased cross sectional area of the pulmonary vascular system
  2. vasoconstriction induced by humoral agents
  3. vasoconstriction induced by alveolar hypoxia
42
Q

are there specific findings for pulmonary embolus in x-ray

A

no

43
Q

if there is infarction what is seen in xray

A

increased alveolar density in infarcted areas, appearing similar to pneumonia

44
Q

what may happen to X-ray with cardiovascular response

A

dilation of pulmonary artery & right ventricular enlargement may cause X-ray to appear similar to pulmonary edema

45
Q

what is a ventilation test

A

patient breaths in xenon gas to test ventilation

46
Q

what is perfusion test

A

intravenous injection of radiolabled particles (iodine or technetium) goes through right heart into pulmonary vascular system. if blood flow is decreased or absent past embolus fewer particles are present in that area

47
Q

what is the gold standard used to confirm the presence of pulmonary embolism

A

pulmonary angiography

48
Q

what is a pulmonary angiography

A

catheter is advanced into right heart and radio opaque die is injected into artery and X-rays are taken

49
Q

how is a pulmonary embolism confirmed with pulmonary angiography

A

dark area appears on angiogram distal to emboli bc radiopaque material is prevented from flowing past obstruction

50
Q

does this procure have risks

A

none unless:

  1. severe pulmonary hypertension greater than 45mmhg
  2. patient is in shock or allergic to contrast medium
51
Q

what is the best treatment

A

prevention by avoiding venous stasis

52
Q

what are other ways to treat with prevention

A

low - dose heparin given subcutaneously
tightfitting stockings
pneumatic stockings or boots
active or passive leg movements

53
Q

when are fibrinolytic agents only used and why

A

due to excessive risk of bleeding they are only used when hemodynamic instability is severe

54
Q

respiratory care treatment protocols

A

oxygen therapy
aerosolized medications
mechanical ventilation

Cardiopulmonary Science (8 decks)

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