Pulmonary Embolism (PE)

Question 1

Structural abnormalities

Answer 1

Blockage of part of pulmonary arterial tree due to embolism

Question 2

Physiological abnormalities

Answer 2

Impaired perfusion of alveoli –> low O2 levels in blood

Question 3

Prior events

Answer 3

DVT

Valsalva Manoeuvre- trying to breathe out against a glossed upper airway

Question 4

Symptoms

Answer 4

Sudden onset dyspnoea, tachypnoea, chest pain of a pleuritic nature (worsened by breathing), cough and hemoptysis (coughing up blood)
15% sudden deaths

Question 5

Signs

Answer 5

cyanosis (usually lips and fingers)
collapse
circulatory instability due to decreased blood flow through lungs and LHS heart
Pleural friction rub (occasionally) heard over affected area
Strain on R. ventricle may be detected
Raised jugular venous pressure

Question 6

Abnormal test results

Answer 6

Low O2 sats
Low O2 on blood gases
lung scan shows lack of blood flow to part of lung
CT shows blood clot in pulmonary artery

Question 7

Treatment

Answer 7

Start O2 at high flow rate

Thrombolytic drugs given by IV infusion to dissolve clot

Question 8

Secondary prevention

Answer 8

Anticoagulants given immediately and for months following

initially low molecular weight heparin by injection and later oral warfarin