Pulm Vascular Disorder: Pulmonary Embolism Flashcards
What is Pulm Embolism?
thrombus within pulmonary arterial bed
Embolism ______ blood flow within _______
obstructs
vessels
Pulm Embolism has a high _______ rate (%?)
mortality
30
What happens if embolus fully obstructs a large vessel?
death will occur
Embolism is the _______ and the result is the _______
process
embolus
Etiology of Pulm Embolism (4)
- usually DVT
- fracture
- air
- amniotic fluid
Etiology: How does DVT contribute to Pulm Embolism? What veins are associated?
formation of thrombus in the deep veins that embolizes and reaches the pulm circuit
Iliac, femoral, popiteal, great saphenous veins of leg
When is DVT life-threatening?
when the thrombus breaks down and form an embolus which travel to a vital organ circulation
Describe how an embolus travel to the pulm circuit starting from the inferior vena cave.
inferior v. c. –> R. atrium–> R. ventricle–> pulm artery–> pulm capilleries–> pulm veins–> clot gets caught in the smaller vessles of pulm circuit
How does a bone fracture lead to Pulm Embolism?
bone fracture–> fat in bone marrow released—> fat enter the circulation and moves as an emboli—> reaches pulm circuit –> resulting in obstruction
Bone is richly ________
vascularized
How does air lead to Pulm Embolism?
air from syringe or tubing enter the circulation and moves as an emboli—> reaches pulm circuit resulting in obstruction
How does amniotic fluid lead to Pulm Embolism?
amniotic fluid rupture during delivery (vessels are severed too) and enter circulation –> cause an obstruction in pulm circuit
Fig. 29.15 What is the saddle embolus named after? What is it?
named after the saddle like appearance of an embolus
created by a thrombus setting at an area where pulm vessels bifurcate, attracting platelets, and causing the thrombus to increase in size
Patho: How does it cause obstruction? What does it result in?
embolus from DVT getting into the arterial blood –> obstruct the vessels –> perfusion impaired
Patho: What does decrease perfusion and thrombus attract? What does it do and release? Why?
decrease perfusion–> platelet attracted to the site of thrombus d/t vessel abnormality —> platelet degranulates –> release mediators to attract more platelets–> constriction of bronchi and pulmonary artery–> hemodynamic instability
Patho: NS reflexively cause ___________ triggered by _____ d/t prob with the a/w. It is a _____ not ________.
bronchoconstriction
brain
reflex
Beneficial
Patho: ventilation:perfusion imbalance leads to ______ and systemic ________
hypoxemia and hypoxia
Patho: Why is there less blood being pumped into systemic circuit?
there is a decrease CO d/t obstruction in the lungs —> less blood flow into L side of heart
Patho: What is surfactant? Why is there decrease surfactant? What does it result in?
surfactants are secretion from cell lining of the alveoli to prevent walls sticking to one another during exhalation
with impede circulation, there is decrease fluid available to form surfactant
T2 alveolar cells that produce surfactant are ischemic and decrease fxn–> decreasing surfactant levels –> atelectasis
Patho: Pulm Embolism leads to _____ _____ _____. Why?
Right Heart Failure
obstruction in pulm circuit–> right ventricles is pumping against increase resistance–> increase workload of R. side of heart —> R-sided HF
Manifestations depends on ____ and _______. Why?
size and vessel
large vessels = no circulation in pulm circulation–> major consequence
small vessels = less severe consequence
Manifestations Pulm Embolism (5)
- dyspnea
- tachypnea
- chest pain
- tachycardia
- fever w/ or w/o infection
Why does dyspnea occur?
impaired GE—> hypoxia –> dyspnea
What are comp mech (2)? Explain
- tachypnea is a comp mech to hypoxemia and hypoxia
2. tachycardia is a comp mech to inadeq. perfusion and decrease CO
Why causes chest pain?
d/t inadequate venous return to the L side of heart –> lack of perfusion in pulm circulation–> forms angina
Diagnosis (7)
- hx and px
- ABGs
- D-dimer
- LDH3
- lung scan (131 I-HAS, IV)
- chest CT
- Pulm Angiogram
What do ABGs measure?
pH, pCO2, and pHCO3 in arterial blood
What is D-dimer? How does it dx Pulm Embolism? Is it a serum marker?
D-dimer is one of the protein fragment when blood clot get dissolved in breakdown of fibrin
used to rule out Pulm Embolism, DIC, and DVT
YES
What is LDH3? What is the 3? How does it dx Pulm Embolism?
protein called lactate dehydrogenase which is released when cells die
3 = subclass specifically for alveolar tissues
Used as a marker for cellular damage in lung –> increase LDH3 = increase damage
How is the lung scan used for dx? What is 131 I-HAS, IV? More or less invasive?
albumin is labelled with iodine 131 and allowed to flow freely thru circulation into pulm circulation and isotope can be detected @ point of obstruction
131 I = isotope of iodine (labelled)
HAS = human serum albumin
provide adequate info
NONINVASIVE
How is Pulm angiogram used? More or less invasive?
catheter inserted into the coronory arteries of the pulm circuit –> contrast medium to detect the obstruction in the flow of blood
More invasive but effective and direct
Treatment of Pulm Embolsim (4)
- stat intervention = better prognosis
- maintain cardiopulmonary function eg remove clots
- thrombolytics and anticoagulation –> to dissolve thrombus and to control platelets
- address underlying cause eg DVT
