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Causes and symptoms
- coughing up a lot of blood
- pain caused by movement
- leg swelling
- bluish skin
- swollen neck veins
The effects of pulmonary embolism will depend on the size of the embolus and the amount of lung tissue involved. When an embolus becomes lodged in a pulmonary blood vessel, it prevents adequate blood supply to the lung, interferes with the exchange of oxygen and carbon dioxide, and results in arterial hypoxemia. As pressure within the obstructed pulmonary artery increases there is strain on the right ventricle and it may eventually fail. Two other complications are pulmonary infarct and pulmonary hemorrhage.
Signs and symptoms of pulmonary embolism vary greatly, depending on the extent to which the lung is involved, the size of the clot, and the general condition of the patient. Simple, uncomplicated embolism produces such cardiopulmonary symptoms as dyspnea, tachypnea, persistent cough, pleuritic pain, and hemoptysis. Apprehension is a common symptom. On rare occasions the cardiopulmonary symptoms may be acute, occurring suddenly and quickly producing cyanosis and shock.
Fibrinolytic therapy should be initiated as soon as possible for patients with massive or unstable pulmonary embolism. heparin will not dissolve existing clots but is a drug often used in treatment of the condition; it prolongs clotting time and allows the body time to resolve the existing clot. The drug most often used in the treatment of PE is heparin, which prolongs clotting time and allows the body time to resolve the existing clot.
Preventive measures include passive or active dorsiflexion of each foot at least ten times each hour; turning, coughing, and deep breathing after surgery; early ambulation whenever possible; and avoidance of pressure, such as propping pillows under the knees or bending the bed at the knees, that could produce venous stasis. Since patients receiving continuous intravenous therapy also are at risk for formation of clots and emboli, intravenous sites should be changed at frequent intervals.
Detection of pulmonary embolism in its earlier and more treatable stages demands constant vigilance for signs that a clot is forming or an embolus is in the blood stream. The more common signs of simple, uncomplicated embolism are listed above. Additionally, the patient is watched for increased jugular pressure, elevated pulse and heart rate, and friction rub. Eliciting Homans' sign (discomfort behind the knee on forced dorsiflexion of the foot), noting skin and temperature changes in the area of the calf, and assessing edema of the extremities are important monitoring activities in the care of patients at risk for pulmonary embolism.
pulmonary embolism (PE)
pulmonary embolismThe migration of an embolus of material, often a blood clot, from elsewhere in circulation that lodges in the pulmonary arteries, occluding same and causing pulmonary infarction, right heart failure and decreased oxygenation. Most (95%) pulmonary emboli (Pes) originate in the deep (popliteal, femoral, iliac) leg veins. Pes cause about 4% of all US hospital deaths/year and are largely preventable.
Dyspnoea, chest pain, tachycardia, tachypnoea, low-grade fever, ± haemoptysis, syncope, ± signs of DVT (e.g., right ventricular heave, right-sided S3, rales). PE is underdiagnosed as the classic signs of dyspnoea (seen in 59%), chest pain (17%) and haemoptysis (3%) are absent, or the patient may be unable to communicate as he or she is comatose or sedated.
▪ CXR—Usually normal; rarely, Hampton sign (wedge shaped infarct) or Westermark sign (reduced blood in embolic lung zone).
▪ VQ scan—Lung mismatch.
▪ Pulmonary angiogram—Accurate, but a high-risk procedure.
▪ Ultrasound—DVT may be seen.
▪ EKG—Sinus tachycardia, nonspecific ST-T wave changes (pathognomonic SI, QIII, TIII).
▪ ABG—Respiratory alkalosis (increased pH, decreased CO2 < 80 mm Hg).
Blood stasis, immobilisation, CHF, surgery, trauma, venous endothelial damage, hypercoagulability (e.g., pregnancy, postpartum), oral contraceptives, protein C deficiency, protein S deficiency, factor V (Leiden mutation), malignancy, severe burns.
Early post-surgical and postpartum ambulation, exercise if patient is bed-ridden, anticoagulation, inferior vena caval filters.
Heparinisation; long-term anticoagulation with warfarin.
pulmonary embolismPulmonary embolus, pulmonary thromboembolism Internal medicine The migration of an embolus of material, often a blood clot, from elsewhere in circulation, lodging in the pulmonary arteries, occluding same and causing pulmonary infarction, right heart failure, and ↓ oxygenation; most–± 95% originate in the deep–popliteal, femoral, iliac leg veins; PE causes ± 4% of all US hospital deaths/yr–50,000, and is largely preventable Clinical Dyspnea, chest pain, tachycardia, tachypnea, low-grade fever, ± hemoptysis, syncope, ± signs of DVT–eg, right ventricular heave, right-sided S3, rales; PE is underdiagnosed as the classic signs of
dyspnea–seen in 59%, chest pain–17%, and hemoptysis–3% are absent, or the Pt may be unable to communicate as he/she is comatose or sedated Imaging–CXR Usually normal, rarely Hampton sign–wedge shaped infarct or Westermark sign–low blood in embolic lung zone; VQ scan Lung mismatch Pulmonary angiogram Accurate but a high-risk procedure in these Pts Ultrasound DVT may be seen EKG Sinus tachycardia, nonspecific ST-T wave changes–pathognomonic SI, QIII, TIII ABG Respiratory alkalosis– ↑ pH, ↓ CO2 < 80 mm Hg Risk factors Blood stasis, immobilization, CHF, surgery, trauma, venous endothelial damage, hypercoagulability–eg, pregnancy, post-partum, oral contraceptives, protein C deficiency, protein S deficiency, factor V–Leiden mutation, malignancy, severe burns Prevention Early post-surgical and postpartum ambulation, or exercise if Pt is bed-ridden, anticoagulation, inferior vena caval filters Management Heparinization; long-term anticoagulation with warfarin.
pul·mo·nar·y em·bo·lism(PE) (pul'mŏ-nar-ē em'bŏ-lizm)
pulmonary embolismAbbreviation: PE
In the hospitalized patient, early mobilization, administration of prophylactic anticoagulants, and compression stockings (elastic or pneumatic) may prevent deep venous thrombosis (DVT). Vital signs, oxygen saturation, respiratory effort, breath sounds, cardiac rhythm, and urinary output are monitored closely in affected patients. Signs of deterioration are promptly reported. The nurse assists with diagnostic studies and medical treatment and provides explanations of procedures and treatments, analgesics for pain, prescribed medications, supplemental oxygen, patient education, and emotional support. Once the pain is stable, the patient is encouraged to resume normal activities. After a pulmonary embolism most patients remain on anticoagulant therapy for at least 6 months. The patient is taught about taking the medication dosage precisely as prescribed, bleeding signs to be reported, avoidance of over-the-counter and prescription drugs that may influence anticoagulation, regulation of foods high in vitamins, and the need for frequent blood tests to ensure appropriate levels of anticoagulation. See: International Normalized Ratio.
In patients who cannot use anticoagulants, a filtering device may be inserted transvenously into the vena cava to try to prevent blood clots from embolizing from the legs to the heart and lungs.
pulmonary embolismOcclusion of a main lung artery or one of its branches by an EMBOLUS, usually a large blood clot that has been carried in the bloodstream from a deep leg or pelvic vein where it has formed as a result of PHLEBITIS. A large pulmonary embolism is usually fatal and is a much-feared complication of recent surgery or pregnancy with prolonged immobilization and inadequate movement of the limbs. Moderate-sized emboli cause chest pain, breathlessness, dizziness from low blood pressure and coughing up of blood. Repeated small emboli may cause PULMONARY FIBROSIS or PULMONARY HYPERTENSION. Treatment is with an anticoagulant drug to reduce the clotting ability of the blood and with thrombolytic drugs to help to dissolve the clots. In a massive pulmonary embolism life may sometimes be saved by an emergency operation to remove the clot.
pul·mo·nar·y em·bo·lism(pul'mŏ-nar-ē em'bŏ-lizm)
Patient discussion about pulmonary embolism
Q. Does anyone have any experience or suggestions regarding aerobic exercise post DVT and/or PE?
Q. What is the differential diagnosis of chest pain in a 35 year old woman? I am a 35 years old woman. I suffer from chest pain for about 24 hours. I just came back from a trip to Europe, and i feel really bad. I smoke and I take anti contraceptive and i know that I am at a risk for pulmonary embolism or costochondritis. Cat it be something else?
It can start in costochondritis if u carried a lot of luggage or might be pulmonary embolism if you didn't move from the chair all the flight. But it can also be a sign for an acute coronary syndrome (even at the age of 35) or a pericarditis. To be sure you need to consult with your GP.