clot or other material lodges in vessels of the lung
what are pulmonary emboli most often associated with?
age greater than 50
statistics regarding PE
*AFFECTS AT LEAST 500,000 PEOPLE A YEAR IN THE U.S.,
APPROXIMATELY 10% OF WHICH DIE
*3rd LEADING CAUSE OF DEATH
*MANY DIE WITHIN 1 HR OF ONSET OF SYMPTOMS BEFORE DX MADE
What causes a pulmonary embolism?
A blockage of artery by a blood clot.
Where do PEs originate from?
long veins or pelvis
may originate in the atria
closure of a blood vessel due to blockage
with occlusion, substances are released from the clot, what does this result in?
resulting in constriction of regional blood vessels and bronchioles
when constriction of regional blood vessels and bronchioles occurs, what does this result in?
this results in increased vascular resistance
what does the resistance and constriction result in?
this in turn increases work load of right heart
when the work load of the right heart is increased, what can this result in?
this can result in right heart failure
decrease in systemic blood pressure
and development of shock
the temporary cessation or slowing of the venous blood flow
risk factors for venous stasis
prolonged periods of sitting
spinal cord injury
increased ability of the blood to coagulate
to thicken, clot
risk factors for hypercoagulability
tumor (pancreatic, gastrointestinal, genitourinary, breast, lung)
increased platelet count (splenectomy, polycythemia)
disease risk factors for PE
other risk factors for PE
oral contraceptive use
hx of DVT or PE
SUBMASSIVE Signs and symptoms of PE
decreased breath sounds over affected area
Crackles; wet crackling noise in lungs during inspiration
pleuritic type chest pain
sharp stabbing pain on inspiration, dry cough
MASSIVE PE signs and symptoms
More severe mani- festations of S&S
Decreased urine output
Cool, clammy skin
Elevated pulmonary artery pressures
Signs of acute right heart failure
elevated pulmonary pressure resulting from an increase in pulmonary vascular resistance to blood flow through small arteries and arterioles.
coughing up blood
arterial blood gases
clinical test on arterial blood to identify the levels of oxygen and carbon dioxide
what can ABGs and pulse oximetry reveal?
ABG studies and pulse oximetry may reveal hypoxemia but are not sufficient to make the diagnosis of PE.
assessment findings with a PE
fearful, apprehensive, with a feeling of impending doom
what may a patient have a history of?
history of leg pain especially in calf or knee area
traveled recently with prolonged sitting
had a blood clot before
had recent surgery
ever been on anticoagulants
given birth or is on contraceptives
sedentary life style
diagnosis of PE
Chest x-ray usually
Ventilation-perfusion Scan (Ventilation Perfusion Scan (V/Q Scan)
A negative V/Q scan r/o PE
An inconclusive scan warrants pulmonary angiography: Specific
& Definitive Test
Spiral CT is now being done to non-invasively DX PE
a scan that tests whether a problem in the lungs is caused by airflow (ventilation) or blood flow (perfusion)
a method of processing computerized tomography data to provide rapid, three-dimensional images of internal organs
special X-rays of the vessels of the lungs.
Fat embolism syndrome
occurs when fat enters the blood stream
what is fat embolism often preceded by?
long bone fracture
principle clinical features of FES?
respiratory failure, cerebral dysfunction, and petechiae
small, pinpoint hemorrhages
The reduction of breathing to the point where oxygen intake is not sufficient to support life
discuss the mechanical theory of FES
FES results from physical obstruction of the pulmonary and systemic vasculature with embolized fat.
discuss the biochemical theory of FES
Circulating free fatty acids are directly toxic to pneumocytes and capillary endothelium in the lung, causing interstitial hemorrhage that can result in vascular injury and ARDS
cells lining the alveoli of the lungs
goals of treatment of ARDS
Increase alveolar gas exchange
Improve pulmonary perfusion
treatment of PE
- May need mechanical ventilation
-Less severe cases, oxygen by mask or NC
Thrombolytic therapy with lysing agent such as TPA
Surgical intervention with embolectomy
Insertion of Vena Cava Filter (Greenfield Vena Cava Filter)
a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream
What is ECHMO used specifically for?
puts oxygen into the blood and takes out carbon dioxide just like our lungs do.
What should be monitored during treatment of PE
What type of BP support may be needed in treatment of PE?
inotropic agents such as dopamine
prevention of PE
applying pneumatic stockings
avoiding prolonged sitting
being vigilant about central venous catheter removal
frequent physical assessment