Pulmonary Embolism

obesity paradox 2

door peyton lawrence

Module 3: Concept Map

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Jaskit

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Smoking Disadvantage

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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),

Pulmonary Embolism

obesity paradox 2

Module 3: Concept Map

Jaskit

Smoking Disadvantage