Pulmonary Embolism

Pulmonary Embolism (PE)

• Thrombus

• Fat

• Air

• Tumor

Pulmonary Embolism Pathophysiology

• Hyperventilation

• Hypoxemia

• Hypocapnia

• Respiratory alkalosis

• Increased PVR

V/Q Mismatch

How is cardiac output affected by increased pulmonary vascular resistance?

How does the change in cardiac output affect the blood flow through the body?

Pulmonary Embolism - Risk Factors

• Age — 45+

• Genetics

• Males

• African Americans

• Heart failure, A-fib, A-flutter

• Lower limb fractures

• Pregnancy, obesity

• Smoking

• Estrogen-based OCPs

Pulmonary Embolism - Clinical Manifestation

• Dyspnea

• Chest pain

• Cough

• Shock

• Arrhythmia

• Syncope

• Hemodynamic collapse

Pulmonary Embolism - Labs and Diagnostics

• CT pulmonary angiogram

• ABG analysis

• Troponin levels

• D-dimer

• ECG

• Ultrasound

• CXR

• Lung scintigraphy (V/Q scan)

Pulmonary Embolism - Treatment/Therapy

1. Supplemental oxygen — mechanical ventilation or ECMO may be necessary

2. Thrombectomy (if medications ineffecive)

Enoxaparin, Dalteparin

Drug class: LMWH — anticoagulants

Action: prevents clot formation/enlargement

Notes: lower risk for bleeding than heparin

Fondaparinux

Drug class: UFH — anticoagulant

Action: prevents clot formation/enlargement

Notes: lower rsk for bleeding than heparin

Alteplase/t-PA

Drug class: thrombolytic

Action: breaks down clots

Notes: high risk for bleeding — contraindicated for HTN and brain bleeds

Which of the following are predisposing risk factors for VTE? Selected all that apply,

a. Lower limb fracture

b. Chemotherapy

c. Elevated PaCO2 levels

d. Major trauma

e. Bed rest duration of 24 hours

A, B, D

A pulmonary embolism is suspected in a patient with a DVT who develops dyspnea, tachycardia, and chest pain. Diagnostic testing is scheduled. Which test does the nurse most anticipate teaching the patient about?

a. D-dimer

b. Chest X-ray

c. CT pulmonary angiogram

d. Ventilation-perfusion lung scan

C