Pulmonary Embolism

Results in?

Deadspace condition (ventilation without perfusion)

Blood clots develop because of?

• Venous stasis (inactivity, CHF, varicose veins)

• Fat/air emboli

• Trauma

• Surgery

• Obesity

• Pregnancy/childbirth

General appearance

• Anxious

• Diaphoresis

• Cyanosis

• Cool or clammy skin

Respiratory pattern

SOB and tachypnea

Cough

Possible hemoptysis

History

Sudden onset of signs and symptoms

CXR

• Increased densities

• Dilation of pulmonary arteries

• Wedge-shaped infiltrates

Hemodynamics

Increased PAP

Capnography (P_eCO₂)

Decreased P_eCO₂ (false reading) with normal or high P_aCO₂ (true reading)

VD/VT (physiological dead space-to-tidal volume ratio)

Increased

Special tests

• Spiral CT scan (best)

• V/Q scan

• Pulmonary angiogram

Prevention

• Anticoagulants (heparin)

• Anti-embolism (compression) stockings

• Pneumatic compression devices

• Early ambulation

Oxygen therapy to remain PaO2 at?

>80 torr

What should be given for chest pain?

Analgesics

What should be given to maintain circulation?

Digitalis and digoxin (positive inotropic agents)

Emergency clot busters?

Thrombolytics (urokinase, streptokinase, tPa)