Pulmonary Vascular Disease Flashcards
Diet Cor Pulmonale
Low Na+
Fluid Restrictions
Small Frequent Meals
Blockage obstructs blood supply to lung tissue, ↑ RV workload, ↓ perfusion to lung
PE
Most Common Cause of PE
DVT
Greater risk of above knee clots embolizing (iliofemoral vein)
Risk factors for DVT (Triad)
Venous stasis
Endothelial injury
Hypercoagulability
Cause Hypercoagulability
deficiency in antithrombin III, protein C - protein S, dehydration
- Recent central venous instrumentation
- Venous insufficiency
- Stroke*
- Pregnancy
- Maglignant neoplasms*
- Prior DVT *
- Right ventricular failure
- Paralysis*
Increased risk for DVT
Immobility * Atherosclerosis Obesity* Estrogens Surgery or trauma* History of heavy smoking* Sepsis Hypertension
Increased risk for DVT
Sudden onset dyspnea Feeling anxious Tachypnea Tachycardia Low PaCO2
PE
Shock Pallor Severe dyspena Crushing chest pain Pulse rapid and weak or PEA Low BP
Massive PE
50% obstruction
cor pulmonale results
60 % obstruction
death
Crushing chest pain Pulse rapid and weak or PEA Low BP Shock Pallor Severe dyspena ECG: shows right ventricular strain
Massive PE
CXR PE
not Dx for PE
Chest CT PE
most frequently used
Reveals pulmonary abnormalities
Most specific, but MOST risk
Use cath and dye
Rarely used to Dx PE
Pulmonary Angiography
PaO2< 35mmHg
PE ABGs
ECG DVT/PE
NOT Dx
Inferior vena cava filters
Greenfield
Gunther Tulip
Tx PE esp w/ DVT
Bed Rest post DVT
Bedrest 2-3d
Hyperventilation Hypoxemia Atelectasis Pulm. infarcts at site of injury/necrosis Right heart failure Hemorrhage Pleural effusion Pulm. HTN
Complications of PE
entry of air into venous system as result of trauma or iatrogenic complications
Venous air embolism (VAE)
lead to inflammatory changes in pulmonary vessels: direct endothelial damage, accumulation of platelets, fibrin, neutrophils, and lipid droplets
Venous Air Embolism
VAE results in
right ventricular dysfunction and pulmonary injury
½ ml air in L coronary artery
can cause V fib
2-3 mL of air into cerebral circulation
can be fatal
S/S VAE
Dyspnea Chest pain & Tachycardia Hypotension Altered sensorium Circulatory shock or sudden death (patients with severe VAE)
VAE Severity of S/S related to
degree of air entry
VAE Positioning
Trendelenburg position-rotate toward left lateral decubitus position
