Unit 1: Pulmonary Embolism (PE) Flashcards
What are the three types of emboli?
- Air
- Liquid
- Solid (blood clot)
What happens when a large emboli obstructs pulmonary blood flow?
Reduced gas exchange → reduced oxygenation → pulmonary tissue hypoxia → decreased perfusion → DEEEEEEEEAAAAAAATH
3 parts of Virchow’s triad
- Hypercoagulability
- Vascular damage
- Circulatory stasis
REVIEW: Name some things that could cause Hypercoaguability
- Dehydration
- Infection/sepsis
- Inherited thrombophilia
REVIEW: Name some things that could cause vascular damage
- Thrombophlebitis/cellulitis
- Venipuncture/IVs/CVADs
- Indwelling cath/heart valve
REVIEW: Name some things that could cause circulatory stasis
- Immobility
- venous obstruction (obesity, tumor, pregnancy)
- Varicose veins
- Afib/left ventricular dysfunction/bradycardia
Most common cause of a PE and the #1 prevention priority is…
DVT! Want to prevent these buggers
Name some DVT Prevention, especially after surgery (8)
- Ambulation ASAP
- ROM exercises + position changes q 2 hrs if immobile
- Pneumatic compression devices as prescribed
- Anticoagulant therapy after bleeding risk is subsided
- low-dose anticoags or anti-plts
- Peripheral circulation assessment q 8
- Alternating pressure mattress (NOT pillows) to reduce pressure under popliteal space.
- Elevate affected limb 20 degrees or more above level of heart to improve venous return
- Avoid crossing legs, tight garters, girdles, & constricting clothes (lol we’re in the 19th century I guess…)
- Refrain from massaging leg muscles
- Inferior vena cava filter (IVC) placed preop for pts who’ll be stuck in bed for long time & have ongoing risk; removed when fully ambulatory
(pg. 587)
The Respiratory S/S of a PE are r/t…
The Cardiac S/S of a PE are r/t…
Decreased gas exchange!
Decreased tissue perfusion!
Resulting Sxs vary depending on size + type of emboli
What’s the most commonly occurring Symptom r/t a PE?
Sudden onset of dyspnea (SOB)
Describe the chest pain r/t with a PE:
Sharp, stabbing chest pain on inspiration
How might someone feel (mental status) if they have a PE?
Feeling of IMPENDING DOOOOOM!
Restless, Agitated, Apprehensive
Caused by poor oxygenation!
What assessment finding might you find on the skin r/t a PE? (2)
What kind of fever might a pt present with?
- Diaphoresis
- Petechiae over chest and axillae
Low-grade fever
Name some Respiratory S/S of a PE (4)
- Cough
- Hemoptysis (bloody sputum)
- Tachypnea
- Abnormal breath sounds (crackles, pleural rub)
Name some Cardiac S/S of a PE (7)
- Tachycardia
- Distended neck veins
- Syncope
- Cyanosis (increased O2 demand)
- Hypotension
- Abnormal Hrt sounds (S3 or S4)
- ECG changes (nonspecific + transient T-wave + ST-segment changes, &/or left-axis or right-axis deviations)
Why might hypotension occur with a PE? Is this a big deal?
Right-sided HF due to pulmonary congestion AND inflammatory response
NOT OKAY!
Can result in SUDDEN DEATH due to cardiac arrest or frank shock!
What is the PaO2/FiO2 ratio?
The ratio of arterial O2 partial pressure (PaO2 in mmHg) to the fraction of inspired O2 (FiO2 as a fraction, not %)
Used to determine the severity of lung injury
Diagnostic testing for a PE (5 labs, 5 imaging)
What’s the Gold standard for diagnosis?
Labs:
1. ABG
2. Basic Metabolic Panel (BMP–she said basic, but they’d do a comprehensive…)
3. TrpI
4. BNP
5. DDIM
Imaging:
1. Pulmonary Angiography*** GOLD STANDARD
2. CT-PA
3. CXR
4. Ultrasound (R/O underlying DVT in extremities)
5. Ventilation-Perfusion scan (V/Q)
What would the ABG results look like initially and then as the PE progresses? Explain why this happens.
1st: Respiratory alkalosis
- Hyperventilation/low PaCO2)
2nd: Respiratory acidosis
- Shunting of deoxygenated blood;
- Decreased PaO2/FiO2 ratio, PaCO2 increases
3rd: Metabolic acidosis
- lactic acid buildup due to tissue hypoxia
So what do we do if we suspect our pt has developed a PE? (3)
- Raise HOB
- Oxygen
- GET HAAAAALP! (Call Rapid Response)
What’s the priority planning for a pt with a PE? (3)
- ABGs
- Maintain SpO2 >95%
- Maintain cognitive status baseline
Interventions for a PE (7)
- Raise HOB
- Oxygen
- GET HAAAAALP! (Call Rapid Response)
- Reassure pt
- Assess (Respiratory, Cardiac, skin)
- Imaging
- Admin prescribed Anticoagulants
What assessments/precautions should we be performing if we’re administering anticoagulants?
Bleeding precautions/assessment!
Monitor CBC, aPTT, PT, INR, platelets
Antidotes for anticoags
If the pt with a PE becomes hypotensive, what medications can we administer along with IV fluids?
- Positive Ionotropic agents (milrinone, dobutamine)
- Vasopressors (levophed, epi, norepi)
- Vasodilators (nitroprusside)
