Wk Ten - Pulmonary Embolism | Pleural Effusion

What is a Pulmonary Embolism?

refers to an obstruction of the pulmonary artery or one of its branches by material that originated elsewhere in the body

What can an embolus be?

fat, gas, amniotic fluid, tumors, septic, foreign bodies, parasites

What happens if an embolus travels?

pulmonary thrombus

What is it called if an embolus stays in place?

Deep Vein Thrombosis

How often does a PE happen?

0.38 per 1000 people

Virchow’s Triad (Thrombosis)

Stasis, Vessel Wall Injury, Hypercoagulability

Major Risk Factors for PE

• surgery

• lower limb problems

• obstetrics

• malignancy

• immobility

• previous VTE

Minor Risk Factors for PE

• Cardiovadcular disease

• Oestrogens

• COPD

• Obesity

• Bowel disease

• inflammatory bowel disease

Thrombophilia

• factor V leiden mutation

• prothrombin gene mutation

• hyperhomocystinaemia

• Antiphospholipid antibody syndrome

• Deficiency of antithrombin II protien C or S

• Increased lipoprotien

• High concentrations of factor VIII or XI

How does PE happen?

1. Clot forms

2. Dislodges

3. Lodges in lung - leading to inflammation, infarction, abnormal VQ ratio & cardiovascular compromise

3 things that can cause a clot

Hypercoagulable state, Circulatory state, Vascular wall injury

Hypercoaguability Clot Formation

• malignancy

• prenancy and peripartum period

• oestrogen therapy

• trauma or surgery

• inflammatory bowel disease

• nephrotic syndrome

• sepsis

• thrombophilia

Circulatory Clot Formation

• atrial fibrilation

• left ventricular dysfunction

• immobility or paralysis

• venous insufficiency or varicose veins

• venous obstructions from tumor obesity or pregnancy

Vascular Wall Clot Formation

• trauma or surgery

• venepuncture

• chemical irritation

• heart valve disease or replacement

• atherosclerosis

• indwelling catheters

PE travels to lung or head?

Lung - PE
Head - Stroke

PE symptoms

• dyspnoea

• cough

• wheezing

• hoarseness

• chest pain

• apprehension

• syncope

• tachyponea

• central chest pain

• cynaosis

• lower GCS

• hypoxia

• hypocapnia

• fever

PE on an ECG

• tachycardia

• nonspecific ST segment & T wave

• right ventricular strain

• atrial arrhythmias

• bradycardia

• inferior Q waves

POCUS

Point of Care Ultrasound - advanced diagnostic ultrasonography that is performed and interpreted by the attending physician as a bedside test

How to rule out PE?

NO RISK FACTORS

PE management prehospital

• supplemental O2

• fluids to fix hypotension (250mL IV)

• adrenaline

• thrombolysis

How is PE managed in hospital?

• anticoagulation

• IVC filter

• Thromolysis

• Embolectomy

• ECMO

PE MAIN MANIFESTATION

Chest.resp symptoms, Tachycardia/arrest, Other risk factors

Pleural Effusion

A pleural effusion is a disease of excess fluid accumulating in the pleural cavity (between the visceral and the parietal pleura).

Two kinds of Pleural Effusion

Transduative & Exudative

Pathophysiology of Pleural Effusion

Plasma Osmotic Pressure

9mmHg

Interstitial osmotic pressure

11mmHg

Types of P Effusion

Haemothorax, Empyema, Chylothorax, Cholesterol, Iatrogenic

Haemothorax

Collection of blood (trauma)

Empyema

Collection of pus (infection)

Chylothorax

Milky fluid high in triglycerides (damaged thoracic duct or SVC)

Cholestrol

fluid high in cholestrol build up

Iatrogenic

nasogastric feed or IV solution build up (malinsertion of tubes)

Pleural E Manifestations

• gradual dyspneoa

• dry cough

• chest pain

• fever

• weight loss

• dull percussion

• decrease breath sounds

• tachycardia

• trauma

• POCUS

Pleural E Management Pre Hospital

• supplemental O2

• careful with fluids

• keep pts head off bed 30 degrees

• lateral decubitis positioning

Pleural E Management In Hospital

• treat the cause

• diuretics

• drain the effusion (thoracentesis)`