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    PULMONARY EMBOLISM PowerPoint

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    norbert.wojdylo
    Pulmonary Embolism Signs, symptoms; Causes (Etiology), Diagnostic Algorithm, Treatment

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    PULMONARY EMBOLISM PowerPoint

    Uploaded by

    norbert.wojdylo
    18 views13 pages
    Pulmonary Embolism Signs, symptoms; Causes (Etiology), Diagnostic Algorithm, Treatment

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    Pulmonary Embolism Signs, symptoms; Causes (Etiology), Diagnostic Algorithm, Treatment

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    18 views13 pages

    PULMONARY EMBOLISM PowerPoint

    Uploaded by

    norbert.wojdylo
    Pulmonary Embolism Signs, symptoms; Causes (Etiology), Diagnostic Algorithm, Treatment

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    PULMONARY EMBOLISM

    Cause --- Consequences --- Diagnosis --- Treatment


    • Pulmonary embolism (PE) is the sudden occlusion of a pulmonary artery or
    any of its branches by an embolus (most often a thrombus that had originated
    elsewhere, typically in the large veins of the legs or pelvis = deep vein
    thrombosis)
    • Note: PE can also arise from non-thrombotic sources (e.g., embolism of air,
    amniotic fluid, fat, infected material, foreign body, tumor).

    • PE is a potentially life-threatening condition


    • Why “potentially” ???
    • Oftentimes, its small thrombi that embolize into the lungs – occlude some
    small vessels in one area – then they quickly lyse – and one doesn’t even
    realize anything has happened
    • Because lungs have a dual blood supply (pulmonary arteries and
    bronchial arteries), even if a few pulmonary arteries become occluded by
    small emboli, lung tissue does not undergo any immediate infarction since
    the bronchial arteries are supplying O2

    • Must have relatively large embolus to begin seeing lung infarction


    • In fact, it is only when over 50% of pulmonary arteries are occluded that we
    begin to witness signs of RV failure (When a large embolus acutely
    occludes major pulmonary arteries or when many smaller emboli begin to
    combine)
    • Could lead to RV failure to due to immense increase in RV pressure 
    obstructive shock  decreased cardiac output and death.

    • Massive PE without cardiac arrest – 30% mortality rate


    • Massive PE with cardiac arrest - mortality may be as high as 95%
    • Pulmonary embolism is a recognized reversible cause of cardiac
    arrest and must be actively excluded in the collapsed pulseless
    patient.
    RISK FACTORS for DVT
    Pathophysiology
     Effect on heart Pulmonary vascular resistance

    “Series effect” “Parallel effect”

    Decreases outflow
    from LV

    Note: Hypokinesia
    = Decreased ventricular
    range of motion
    Poor gas exchange in lungs
     V/Q mismatch  decreased
    perfusion (Q)  V/Q to infinity
     less O2 diffusion into pulmonary
    veins beyond the embolus =
    decreased PaO2 = hypoxemia
     dyspnea (difficulty breathing)
     tachypnea (increased breathing
    rate)
    Massive pulmonary emboli may manifest with hypotension,
    tachycardia, light headedness/presyncope, syncope, or cardiac
    arrest.

    The most common signs of pulmonary embolism are


    • Tachycardia (reflex increase in HR)
    • Tachypnea (reflex increase in breathing rate)

    • Hypotension (decreased systemic CO)


    • Could see JVD (decreased venous return due to RV dilation
    and increased RV pressure)
    • Cold extremities (hands and feet) – due to reflexive
    vasoconstriction

    • Pleuritic chest pain


    How do we diagnose a suspected pulmonary embolism ?
    1) Determine clinical probability (of a PE) based on Wells criteria
    Suspected PE in a patient (pre-test probabilities)  Negative D-DIMER RULES OUT PE

     + D-dimer test does not fully rule in PE


     proceed with more specific tests  CTPA

    Fibrin breakdown
    product
    • Grey area within pulmonary arteries = embolus
    • Black = air (can even see L and R primary
    bronchi here)
    Alternate diagnosis pathway

    If patient had
    high probability
    for DVT
    “DOPPLER
    ULTRASOUND”
    Highly
    specific

    *If: morbidly obese,


    allergic to iodine, or Gold standard
    with renal failure

    – takes longer
    - less specific
    Treatment of PE

    • Dissolve! [Fibrinolysis]
    > Anticoagulants (tPA, urokinase,
    heparin IV)
    > Surgically remove –
    embolectomy

    • In patients with hypoxemia, oxygen


    should be given.

    • In patients with hypotension due to


    massive PE (hemodynamic
    instability), 0.9% saline can be
    cautiously given IV; overloading
    the right ventricle can result in
    deterioration

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