Pulmonary Embolism

Question 1

What is a pulmonary embolism (PE)?

Answer 1

PE most commonly originates from a deep venous thrombus (DVT) of the lower limbs. A significant proportion of patients with PE will present with evidence of DVT, however it should be kept in mind that the condition can be caused by other emboli, such as fat, air & amniotic fluid.

Question 2

What are the clinical features of PE?

Answer 2

Clinical presentation ranges from asymptomatic to sudden death.

Clinical features of PE are varied & non-specific. 
Common features:
- Dyspnoea
- Tachypnoea 
- Pleuritic, or substernal chest pain 
- Syncope or near syncope 

Other features:

• Cough
• Haemoptysis
• Low grade fever >37.5
• Signs of DVT (unilateral swelling, redness; localised warmth

Question 3

What are the clinical features of PE?

Answer 3

Clinical presentation ranges from asymptomatic to sudden death.

Clinical features of PE are varied & non-specific.

Common features:
- Dyspnoea
- Tachypnoea
- Pleuritic, or substernal chest pain
- Syncope or near syncope

Other features:
- Cough
- Haemoptysis
- Low grade fever >37.5
- Signs of DVT (unilateral swelling, redness; localised warmth, tenderness, most often presenting in lower limbs)
- Signs of right ventricular dysfunction (S1, Q3, T3 or RBBB)
- Jugular vein distention
- Cyanosis
- Sinus tachycardia
- Shock or hypotension

Question 4

What are the risk factors for PE?

Answer 4

1. History of a DVT or PE
2. Prolonged immobilisation
3. Recent surgery, trauma or hospitalisation
4. Oral contraceptive use
5. Hormone replacement therapy
6. Cancer
7. Pregnancy (higher risk during the postpartum period, especially after a c-section)

Question 5

Outline the management protocol for PE.

Answer 5

Is the patient presenting with cardiovascular instability?

If no, consider:

1. O2
2. Differential diagnosis
3. Analgesia

If yes,
1. Anticipate further deterioration & commence resuscitation as required
2. O2
3. 12-lead ECG
Consider:
4. Differential diagnosis
5. IV fluid (adult 250-500mL, paediatric 10 mL/kg)
6. Adrenaline (CCP)