Pulmonary Embolism

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PMP Notes

luonut Shaun Michel

THE GOALS AND FUNCTIONS OF FINANCIAL MANAGEMENT

luonut Allison Villarreal

Impacts of Heart Diseases in Canada

luonut Gabriela Lee Confesor

Organigram

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Pulmonary Embolism

Complications

DEATH

Recurrent PE

Bleeding (when on anti-coagulants)

Pleural Effusion

Organ injury: pulmonary infarction

L. heart failure

R. heart failure

Diagnostics

Wells Criteria

Malignancy +1

Hemoptysis: +1

Surgery/Immbolization w/in 1 month: +1.5

Tachycardia +1.5

Previous DVT/PE +1.5

Clinical Sxs of DVT: +3

PE is more likely than other diagnosis: +3

EKG

non specific ST and T- wave abnormalities

Tachycardia, pseudo RBBB, S1Q3T3

Imaging

(Spiral) CT / Pulmonary Angiography

Wedge-Shaped Infarct

Decreased Vascular Filling

(Compression) Ultrasound w/ Doppler

Used to find thrombi

X-Ray

Clear

1. Hamtpon's Sign 2. Fleishner's Sign 3. Westermark Sign

Labs

Other

WBC

Leukocytosis

Arterial Blood Gas

High pH, low PaCO2, low PaO2, increased A-a, normal -> decrease

D-Dimer

Increases after surgery

Highly sensitive (snout)

Pregnancy: >500 for ~ 30 days until decrease.

Treatment/Management

Management

Lifestyle Changes: exercise, stop smoking, mobility,

Vitals: Vasopressors

Compression Socks

Anticoagulants

Non-Pregnancy

Thromboectomy

IVC Filter if anticoagulants are contraindicated

3 Month minimum of warfarin

LMWH, factor Xa inhibitor, tPA (hemodynamically unstable),

Pregnancy/Breast Feeding

tPA

SubQ LMWH

IVC filter if anticoagulants are contraindicated

Clinical Presentation

Sxs

SOB, Pleuritic Chest Pain, Hemoptysis, Tachypnea, Tachycardia, Hypotension, Fever, Decreased Breath Sounds, Loud P2 (S2), Unilateral swelling, erythema, pain with dorsiflexion (Hooman's), Meyer's sign, syncope (w/ saddle emboli),

Asx

Differentials

Post Surgical Complications

MSK

MI

Congenital Defects/ Underlying Disorders

R Sided Heart Failure

Pulmonary Hypertension

Risk Factors

Previous DVT/PE

Previous Surgeries

Hypercoaguability Disorders

Immobility

Malignancy

Smoking

Long Bone Fracture

Pregnancy/OCP

Virchow's

Types of P.E.

DVT

Air

Divers/ Procedures

Amniotic

During Deliver/ Shortly After

Fat

Long Bone fx/ Liposuction/ Brazilian Butt Lift(BBL)

Pathophysiology

Decreased CO: hypotension, tachycardia, vasoconstriction

Increased PVR --> increased RV pressure --> dilation + hypertrophy

V/Q mismatch: increased dead space (V/Q>1), increased TV, RR, O2 sat, A-a gradient, HR, respiratory alkalosis

Embolus dislodges from clot due to HTN,

Pregnancy --> high estrogen levels create hypercoaguable state