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Pulmonary Embolism (Wedge infarct
dual blood supply
therefore rare
…
Pulmonary Embolism
Wedge infarct
dual blood supply
- Necrosis leads to hemoptysis
- Ischemia of pleura: Pleuritic CP
- increased resistance: Pulm HTN
- can produce RH strain :<3:
no blood can get in: VQ mismatch
- V/Q = 0
- CO2 can perfuse: 100% ventilation
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but, size/location of thrombus doesn't matter
Platelet derived mediators matter
- fluid leak
- larger diffusion barrier to O2
- O2 is diffusion limited: wall thickness limits O2
- CO2 is perfusion limited: CO2 always gets out
- delivery of O2 = Hgb x % Sat x CO
- CO = SV x HR
- % Sat falls in PE (Tacypnea)
- body increases Hgb (slow)
- body increases CO
- CO2 drops 2/2 tachypnea
unreliable, but handy model of what can happen
ABG:
- Hypoxemic
- hypercapnic
- high pH (resp alkalosis)
not specific to PE
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DVT
Clot in the deep veins
Path: Virchow's triad
- Venous stasis
- hospitalized pt, bedridden :bed:
- also ppl in long car rides :truck: or travelers :airplane:
- Endothelial Injury
- from central lines
- any plastics increases risk
- also just :smoking:
- Hypercoagulable state
- HRT, OCP, factor V Leiden, malignancy :crab:
- something that makes pt more likely to clot
Fluid from the legs can't get out
ends up in the leg
- distal to clot: Edema
Pt: unilateral leg swelling
Hammond sign
- calf tenderness has no correlation to DVT
- :stars:Difference btw extremities ≥2cm, 2cm below the tibial tuberosity
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- kills people, high morbidity/mortality
- SUPER HUGE TOPIC: "hold onto your butts" :man::skin-tone-6::smoking:
- little path, little tx
- check out the intern videos for more information
- but you still need to know more
- PE could mean many things
- cholesterol emboli
- placental contents
- air emboli (botched central line: this guy here)
- infective endocarditis: embolizing bact.
- We mean VTE: DVT that travels
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