Pulmonary Embolism

Pregnancy --> high estrogen levels
create hypercoaguable state

Embolus dislodges from clot due to HTN,

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

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

Decreased CO: hypotension, tachycardia, vasoconstriction

Fat

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

Amniotic

During Deliver/
Shortly After

Air

Divers/
Procedures

DVT

Virchow's

Pregnancy/OCP

Long Bone Fracture

Smoking

Malignancy

Immobility

Hypercoaguability Disorders

Previous Surgeries

Previous DVT/PE

Pulmonary Hypertension

R Sided Heart Failure

Congenital Defects/
Underlying Disorders

MI

MSK

Post Surgical
Complications

Asx

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),

Anticoagulants

Pregnancy/Breast Feeding

IVC filter if anticoagulants
are contraindicated

SubQ LMWH

tPA

Non-Pregnancy

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

3 Month minimum of warfarin

IVC Filter if anticoagulants are contraindicated

Thromboectomy

Management

Compression Socks

Vitals: Vasopressors

Lifestyle Changes: exercise, stop smoking,
mobility,

Labs

D-Dimer

Pregnancy: >500 for ~ 30 days until
decrease.

Highly sensitive (snout)

Increases after surgery

Arterial Blood Gas

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

Other

WBC

Leukocytosis

Imaging

X-Ray

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

Clear

(Compression)
Ultrasound w/ Doppler

Used to find thrombi

(Spiral) CT /
Pulmonary Angiography

Decreased Vascular Filling

Wedge-Shaped Infarct

EKG

Tachycardia, pseudo RBBB, S1Q3T3

non specific ST and T- wave abnormalities

Wells Criteria

PE is more likely than other diagnosis: +3

Clinical Sxs of DVT: +3

Previous DVT/PE +1.5

Tachycardia +1.5

Surgery/Immbolization w/in 1 month: +1.5

Hemoptysis: +1

Malignancy +1

R. heart failure

L. heart failure

Organ injury: pulmonary infarction

Pleural Effusion

Bleeding (when on anti-coagulants)

Recurrent PE

DEATH