Pulmonary Embolism (Diagnostic Studies (ECG Monitoring (-Not diagnostic…
-Important to monitor but not used to diagnose
-The PaO2 is low because of inadequate oxygenation secondary to an
occluded pulmonary vasculature preventing matching of perfusion to ventilation.
-The pH remains normal unless respiratory alkalosis develops as a result of prolonged hyperventilation or to compensate for lactic acidosis caused by shock.
-Checks the circulation in the large veins in the legs and sometimes the arms
-Shows blockage in veins by blood clot or thrombus formation
Spiral (helical) CT Scan
-Used when PE is suspected, D-Dimer is elevated but venous U/S is normal
-Requires IV contrast media to view the vessels
-Rotating scanner that allows visualization of anatomic regions of the lungs in slices
-Provides 3D images to help visualize the emboli
-Measures amount of cross-linked fibrin fragments that result from clot degradation
*Disadvantage: not specific or sensitive
Troponin & BNP Level
-Not diagnostic but need to monitor
-Associated with increased mortality in the patient
-MOST SENSITIVE AND SPECIFIC FOR PE
-Expansive and invasive
-Catheter in AC or Femoral Vein → pulmonary artery → contrast injected
-Coughing, deep breathing, and using incentive spirometry
• Reassure patient that the correct measures are being taken.
• Apply oxygen by nasal cannula or mask.
• Maintain an IV line for IV medications and fluids
• Maintain bed rest/limit activity
• Place patient in semi/high-Fowler’s position.
• Apply telemetry monitoring equipment.
• Obtain an adequate venous access.
• Assess oxygenation continuously with pulse oximetry.
• Assess respiratory status at least every 30 minutes by:
• Listening with a stethoscope for presence or absence of breath
sounds, crackles, or rubs.
• Measuring the rate, rhythm, and ease of respirations.
• Checking skin color and capillary refill.
• Checking position of trachea.
• Assess cardiac status by:
• Comparing blood pressures in right and left arms.
• Checking pulse for quality.
• Checking cardiac monitor for dysrhythmias.
• Checking for distention of neck veins.
• Ensure prescribed chest imaging and laboratory tests are obtained immediately (may include complete blood count with differential, platelet count, prothrombin time, partial thromboplastin time, Ddimer level, arterial blood gases).
• Examine the thorax for presence of petechiae.
• Administer prescribed anticoagulants.
• Assess for bleeding.
• Handle patient gently.
• Institute Bleeding Precautions.
• Institute fall precautions
-Regarding long-term anticoagulant therapy continues for at least 3-6 months
-INR levels are drawn at intervals; warfarin dosage is adjusted
-Management is similar to that of DVT
-Prevent complications and recurrence
-Reinforce need to return to HCP for refular follow-up exams
-Other sites of origin of PE include: Right side of the heart (especially with atrial fibrillation)
-Pelvic veins (especially after surgery or childbirth)
-Presence of central venous catheters or pacing wires
-Less common causes of PE include
-Fat emboli from (fractured large bones)
-Air emboli from (improper administration of IV therapy)
-Bacterial vegetation's, amniotic fluid and tumors
-Immobility or reduced mobility surgery within the last 3 months (especially pelvic and lower extremities) Hx. of DVT -Heavy cigarrete smoking -obesity- Contraceptives -Prolonged air travel -Heart failure -Clotting disorders
More than 90% of pulmonary emboli arise from deep vein thrombosis (DVT)
commonly originate in the femoral or iliac veins
clinical manifestations depend on the size of the emboli massive emboli produce abrupt hypotension and shock
small emboli may be undetected
patients with cardiopulmonary disease even small to medium sized emboli may result in severe cardiopulmonary compromise
symptoms begin slowly dyspnea most common mild to moderate hypoxemia with a low Paco2
-accentuation of the pulmonary heart sound
-Syncope and sudden change in mental status result of hypoxia
(dead of lung tissue) when the following factors are present
- occlusion of a large or medium sized pulmonary vessel (more than 2mm in diameter
- insufficient collateral blood flow from the bronchial circulation
- preexisting lung disease
infarction results in alveolar necrosis
results from hypoxemia or involvement on more than 50% of the area of the normal pulmonary bed.
-Recurrent emboli may result in chronic pulmonary hypertension
Pulmonary hypertension results in dilation and hypertrophy of the right ventricle
Pulmonary embolism--> is a collection of particulate matter (dolid, liquid, or air)--> that enters the venous circulation and lodged in the pulmonary vessels--> large emboli obstruct the pulmonary blood flow-->leading to reduced oxygenation--> pulmonary tissue hypoxia--> potential cell death