Pulmonary Embolism

Question 1

PE

Answer 1

Diagnosed based on clinical suspicion and the results of specific diagnostic studies. Predisposing rest factors are often in the history; a leading cause of in-hospital death, ultimately as a result of right ventricular failure

Question 2

Risk factors for PE

Answer 2

Prolonged bed rest/immobolity
Oral contracepives
Surgery to long bones
Venous stasis
Hypercoagulable states
Cardiac thrombi

Question 3

Signs and symptoms of PE

Answer 3

*unexplained SOB, and tachy are most commone
Usuallly ocurrs abruptly
Chest pain (retrosternal or laterlized and pleuritic)
Hemoptysis
Low grade fever
Hypotension
Cyanosis

Question 4

Lab and diagnostics for PE

Answer 4

VQ scan
ABG: hypoxemia, hypocapnia
Spiral CT/D-dimer
Pulmonary angiography when clinical data and VQ scan are contraindicated

Question 5

Hypoxemia

Answer 5

SaO2 < 90%

PaO2 < 80%

Question 6

Hypocapnia

Answer 6

PaCO2 < 35

Question 7

Management of PE

Answer 7

Supplemental oxygen
IV fluids for those with hypotension and reduced carbon dioxide
Worsening hypercapnia with progressive obtundation is indication for intubation
Heparin 80u/kg bolus followed by continuous infucion of 18u/kg/hr to maintian a PTT of 1/5-2 x normal; begin coumadin simultaneously to an INR of 2-3
Fibrinolytics therapy in those with hemodynamic compromise or shock before starting fibrinolytics/thrombolytics, PT and PTT must be less than two times normal