Pulmonary Embolism.

Question 1

(1) Pulmonary artery: After blood leaves through the pulmonary valve it travels into the main pulmonary artery and then it branches into the left and right main pulmonary artery then to three segments to supply lobes of the lung and then continues to branch further until it becomes
pulmonary capillaries.

(2) The right ventricle is small with only a thin muscular wall, so it is not built to pump
against high pressures.

(3) If a pulmonary embolism is large enough and lodges in the main
pulmonary artery or at the branch point of the left and right mainpulmonary artery then the puts enormous pressure back up to the RV and the RV goes into failure and
then the patient becomes hypotensive
then cardiac arrests.

Answer 1

Anatomy: Pulmonary Embolism.

Question 2

________ is a clot that travels (usually from the Lower Extremity veins)
and lodges into a pulmonary artery.

The embolus will continue to travel into the pulmonary artery tree until it becomes lodged in a vessel of the emboli’s diameter.

________ is a common and potentially fatal complication of DVT formation.

50-70% of patients with this will have lower extremity DVT when evaluated.

3rd leading cause of death in hospitalized patients

Answer 2

Pulmonary embolism

Question 3

(a) Obstruction of the vascular bed increases dead space (wasted ventilation) and hypoxemia.
(b) Decreased CO
(c) Massive PE may cause RV failure.
(d) Surfactant depletion leads to atelectasis (lung collapsing).

Answer 3

Physiological effects of PE include:

Question 4

(1) Can be very difficult to make a clinical diagnosis.
(2) Chest pain, tachypnea, and tachycardia.
(3) Hypoxemia
(4) SOB
(5) Signs of DVT (unilateral leg swelling, pain, redness) and the above symptoms, you must consider it to be PE until proven otherwise and treated as such.

Answer 4

Symptoms/Physical Findings: PE

Question 5

(1) CXR: Will be normal

(2) EKG: Is abnormal in 70% of patients, however the most common abnormality is Sinus Tachycardia
or non-specific ST and T wave changes.

(3) Helical CT pulmonary angiography is the imaging study of choice.

(4) Ultrasonography of extremities to look for DVT.

(5) D Dimer positive

Answer 5

Labs/Studies/EKG: PE

Question 6

AMI
Pneumonia
OSA
Pulmonary HTN
Anxiety
Infection
Pericarditis
Pericardial effusion/Tamponade
COPD
Asthma

Answer 6

Differential Diagnosis: PE

Question 7

(1) Goal of treatment is the prevention of further ___ propagation or further clot burden due to DVT.

(2) Aggressive anticoagulation with either Heparin or Lovenox (same dosing as DVT).

Warfarin Cumiden

Answer 7

Treatment: PE

Question 8

(1) ABCs, IV, O2 if saturation < 94%.
(2) Anticoagulated
(3) MEDEVAC

Answer 8

Initial Care: PE