Pulmonary Embolism Flashcards
what is a pulmonary embolism?
occurs when a thrombus forms in one of the body’s veins (known as a deep vein thrombosis/DVT) becomes an embolus that gets lodged in a pulmonary artery preventing perfusion and gas exchange
*an embolus may not always be from a thrombus, it can also be an air, fat, or amniotic fluid embolus
what is virchow’s triad?
essentially three things that make for the perfect environment for a thrombus to for
- blood stasis
- hypercoaguability
- damage to vessel walls
what are the signs and symptoms of a pulmonary embolism?
- sudden onset of sharp chest pain that worsens with deep breathing
- shortness of breath
- cough (possibly with blood sputum, typically dry)
- tachycardia
- tachypnoea
- decreased BP
- low O2 saturation
- light-headedness
- generalised weakness
what are the signs of a deep vein thrombosis?
DVT typically occur in the legs but you can look for signs such as redness, swelling, and tenderness on palpation
what key things can lead you toward a provision diagnosis of PE in the pre-hospital setting?
patient history!!!!
- recent surgery
- recent immobilisation for any reason
- long flights or drives
- hypercoaguable state e.g. pregnant, on birth control, smoking, diagnosed condition, etc.
- previous DVT or PE
- story of what happened (sudden pain, sudden SOB)
ECG
O2 saturation
signs of DVT
how is a PE treated pre-hospitally?
there isn’t much that can be done pre-hospitally. Care essentially consists of oxygen therapy, analgesia if required, cardiac monitoring and preparation for potential cardiovascular instability/deteroration, rapid transport to hospital
other than tachycardia, what other changes may be expected on an ECG?
any signs of right ventricular dysfunction
- right bundle branch block
- S1-Q3-T3
why is there often right ventricular dysfunction in pulmonary embolism?
this is due to the sudden increase in pulmonary vascular resistance that the blockage (embolus) causes
what are some differential diagnosis for PE?
- acute myocardial infarction
- pneumonia
- pericarditis
- CHF
- pleurisy
- pneumothorax
- pericardial temponade
when listening to the chest of a patient with PE, what is the most common thing to hear?
normal/clear chest. This is because there is nothing obstructing ventilation, the issue has to do with perfusion
what is a VQ mismatch and why is it a consideration for paramedics?
have to google
describe the process by which a thrombus forms
-describe atherosclerosis too from taxonomy
