Pulmonary Embolism

V/Q ratio?

Should be 1.0

amount of air reaching the alveoli / amount of blood reaching the alveoli

ex. high v/q, more ventilation but less perfusion

• decreased blood but normal ventilation (Pulmonary embolism)

• deadspace

low v/q, less ventilation but more perfusion

• shunt

Risk factors for a DVT

Virchows Triad stuff

Clinical manifestations of a PE, complications?

Dyspnea, SOB, tachypnea, hemoptysis, crackles, wheezing, fever, change in mental status, hypotension, impending doom, death

Pulmonary hypertension, infarction

Diagnostic studies for a PE

D-dimer

• elevated

• false negative with SMALL PEs

CT scan

• most common

• IV Contrast media

V/Q Scan

• if patient can’t have a contrast

• Perfusion scanning + Ventilation scan

  • radioisotope injection + radioactive gas

Nursing care?

• Oxygen: intubation/mechanical ventilation

• Pulmonary hygiene: prevent atelectasis

• Shock: fluids, vasopressors

• HF: diuretics

• Pain: opioids

Drug therapy for PE?

Immediate anticoagulation

• LMWH

• IV heaprin

• Warfarin or alternative

tPA or Alteplase

Surgical therapy for PE?

Percutaneous catheter embolectromy or endovascular ultrasound delivered thrombolysis

• inserted through femoral vein

• complication: Migration, perforation

• IVC Filter!