Pulmonary Embolism

Question 1

What is a Pulmonary Embolism?

Answer 1

A cardiovascular condition where a blockage occurs in one of the pulmonary arteries of your lungs. Blockage causes necrosis in associated tissue.
Presents as 1 of 4 types.

Question 2

Pulmonary Embolism pathophysiology?

Answer 2

Normally caused by blood clots that travel from deep veins, usually DVT. If serious blockage can cause death.

Question 3

What are the low risk factors for PE?

Answer 3

• Bed rest > 3 days
• Elderly
• Obesity
• Pregnancy
• Varicose veins

Question 4

What are some of the moderate risk factors for PE?

Answer 4

• Chronic heart or respiratory failure
• Chemo
• Hormone replacement therapy
• Cancer
• Oral contraceptive therapy
• Recent MI
• Paralytic stroke
• Postpartum
• Thrombophillia

Question 5

What are some of the high risk factors for PE?

Answer 5

• Hip/leg fracture
• Major general surgery or trauma
• spinal cord injury
• History of PE/DVT

Question 6

What are PE S&S?

Answer 6

SYMPTOMS
-Dyspnoea
-Pleuritic Chest Pain
-Syncope/dizziness
-Haemoptysis
-apprehension
SIGNS
-RR>20
JVP
-Pulse >100
-SPO2 < 92 on air
-Signs of DVT
-pyrexia
-cyanosis
-tachnycardia
-Tachypnoea
-hypotension

Question 7

What are the four types of Pulmonary Embolism?

Answer 7

1. Multiple small pulmonary emboli
2. Segmental emboli with pulmonary infarction
3. Major pulmonary emboli obstruction of the larger branches of the pulmonary tree
4. Massive pulmonary emboli

Question 8

What is Multiple small Pulmonary Emboli?

Answer 8

It is characterised by progressive breathlessness more commonly identified at outpatient appointments than through emergency presentation due to the long standing nature of the problem.

Question 9

What is segmental emboli with pulmonary infarction?

Answer 9

Can present with pleuritic chest pain and/or haemoptysis but with little or no cardiovascular compromise

Question 10

What is major pulmonary emboli obstruction of the larger branches of the pulmonary tree?

Answer 10

Can present with sudden onset of dyspnoea with transient rise in pulse and/or fall in blood pressure. Often a precursor to a massive PE

Question 11

What is a Massive Pulmonary Emboli?

Answer 11

Often presents with loss of consciousness, tachypnoea, and intense jugular vein distension. May prove fatal within 1 hour and can be unresponsive to CPR

Question 12

What criteria are used to assess the likelihood of a pulmonary embolism?

Answer 12

The Wells Criteria (see JRCALC)

Question 13

PE A&M?

Answer 13

ABCDE
TC if - extreme difficulty breathing, cyanosis, sats <90%
-Assess A and B and treat as appropriate 
-O2
-Cater history to PE risk factors
-Check legs for pain/swelling/tenderness
-Move on to C
-12 lead
-Transfer