Pulmonary Embolism cliffnotes

Question 1

Define Pulmonary Embolism

Answer 1

Obstruction of the pulmonary artery or one of its branches by a blood clot (embolus)

Question 2

What is Embolus?

Answer 2

A lot that travels via bloodstream from its vessel of origin to lodge in a smaller vessel, blocking blood flow

Question 3

Causes of Non-cardiogenic Pulmonary Embolism

Answer 3

Blood clot from a deep vein of the leg or pelvic area that dislodges and travels back to the heart via venous system into the pulmonary artery

• derived from states of stagnation, venostasis (prolonged immobility), trauma/pain, or surgery
• COPD pts are predisposed due to venous stasis resulting from their thicker blood (polycythemia)

Question 4

Pathophysiology of Pulmonary Embolism

Answer 4

Blood is obstructed to areas of the involved lung, which contributes to dead space ventilation

• CL decreases as atelectasis occurs due to decreased perfusion (bodies response to maintain normal v/q matching)
• Widened A-a results from intrapulmonary shunting and v/q mismiatching

Question 5

Clinical signs and symptoms of pulmonary embolism

Answer 5

• Dyspnea and/or tachypnea
• Hypoxemia
• Chest pain
• Cough and/or pleuritic pain
• Hemoptysis

Question 6

Diagnostic tests for PE?

Answer 6

• V/Q scan
• Pulmonary angiography
• MRI (least reliable)

Question 7

Treatments for PE?

Answer 7

1. Prevention (leg elevation, ambulation, stockings, Heparin)
2. Anticoagulation therapy (Heparin, Warfarin, streptokinase for massive embolus)
3. supplemental O2
4. Vasopressors and Fluids (If hypotension is present)