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Pulmonary Embolism (Clinical Presentation (Cyanosis, Tachypnoea, Pyrexia,…
Pulmonary Embolism
Clinical Presentation
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Depends on the number, size and distribution of the emboli; small emboli may be asymptomatic, where large emboli are often fatal
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Treatment
Thrombolysis for massive PE - can improve pulmonary perfusion quicker than anticoagulation - side effect is risk of bleeding in the brain/gut only use in severe disease
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IV fluids and inotropic agents can be used in severe cases to improve the pumping of the right heart
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Prevention of further emboli long term - placed on vitamin K antagonist e.g. warfarin, target INR is between 2-3, patients mobilised, TED stockings
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Management of massive PE - oxygen if hypoxic, morphine with anti-emetic if patient is in pain, consider immediate thrombolysis if critically ill, IV access start heparin
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Diagnosis
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Plasma D-dimer
D-dimer are elevated in other conditions, so a +ve result is NOT DIAGNOSTIC
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Type of fibrinogen degradation product that is released into the circulation when a clot begins to dissolve
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Pathophysiology
After PE, lung tissue is ventilated but NOT PERFUSED resulting in intrapulmonary dead space and resulting in impaired gas exchange
After some hours, the non-perfused lung NO LONGER PRODUCED SURFACTANT resulting in alveolar collapse which in turn exaggerates hypoxaemia
Arise from a venous thrombus in the pelvis/legs, goes through IVC, to right side of heart, into pulmonary circulation, where it becomes lodged
Key Facts
Bronchial circulation provides blood to the lung tissue itself - bronchial circulation originates from the aorta
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Differential Diagnosis
Asthma, COPD, MI, pneumonia and heart failure