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PULMONARY EMBOLISM/ PH: (CLINICAL S/S: (Sudden SOB, cardiac arrhythmia: A…
PULMONARY EMBOLISM/ PH:
RESPIRATORY MANAGEMENT
Oxygen Therapy Protocol - tx for hypoxemia, decreases WOB/myocardial work. *Fio2 100% to maintain PaO2 > 80
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Medication therapies (time sensitive therapies) Anticoagulants (Heparin); Thromobolytics (Urokinase, Stretptokinase, tPA); maintain circulation (Digoxin or Digitalis)
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Patient education- Walking, exercise, fluids, compression stockings
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DIFFERENTIAL DIAGNOSIS
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Pulmonary HTN: right, left or biventricular heart failure
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CLINICAL S/S:
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cardiac arrhythmia: A-fib, A-flutter, atrial tachycardia, BBB
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Wheezing, crackles, pleural friction rub (if pleura involved)
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Inc pH, Dec PaCO2, Dec HCO3- , Dec PaO2, Dec SaO2/SpO2
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Dec pH, Inc PaCO2, Inc HCO3-, Dec PaO2, Dec SaO2/SpO2
Pulmonary Embolism/pulm HTN: increased density, hyperadiolucency distal to PE, dilation of pulm arteries,R vent cardiomegaly, pleaural effusion. Not recommended for detecting location of PE.
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Pulmonary Infarction (severe) : atelectasis, consolidation, tissue necrosis... leading to blockage of the pulmonary vasculature which will cause pulm HTN/shunting.
Ex: saddle embolus (large) disrupts the R heart, lodging in the pulm artery
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Checks for clotting: d-dimer , PT/PTT/INR
CBC: RBC, Hgb, HCT, lactic acid