Etiology/Risk Factors
During which time period do mothers have an increased risk for pulmonary embolism?
Pregnancy and the postpartum period (~6 weeks)
In a pulmonary embolism, which of the following would most likely be the V/Q in dead space?
A) 0
B) 1
C) infinity (∞)
infinity (because Q = 0 due to lack of perfusion)
Sudden-onset dyspnea, pleuritic chest pain, syncope, and hemoptysis
What are the symptoms of PE?
CT Pulmonary Angiography
What is the diagnostic test of choice for pulmonary embolism?
Anticoagulant; LMWH (Low-Molecular Weight Heparin)
What is the primary treatment for PE?
Stasis of blood flow, Endothelial Injury, and Hypercoagulability
What is Virchow's Triad?
What will happen to cardiac output as a result of a pulmonary embolus?
It will decrease (backup in the RV due to obstruction --> increased afterload).
In a patient with pulmonary embolism, V/Q lung scan will show mismatch due to abnormal _______.
perfusion
Diagnostic tool used to determine a person's probability of having a pulmonary embolism.
What is a Modified Wells score?
Thrombolytic therapy is given when patients are _______.
What is hemodynamically unstable?
Fat arising from a long bone fracture that obstructs the pulmonary arteries.
What is a fat embolus?
What is the effect of pulmonary artery obstruction on pulmonary artery pressure and pulmonary vascular resistance, respectively?
Both values increase
What is an EKG abnormality you might see in a patient with a pulmonary embolus?
S1Q3T3 abnormality (big S wave in Lead I, and a Q wave and inverted T wave in Lead III). Sign of right heart strain.
May be seen on CTPA in a patient with a pulmonary embolism.
What are vascular filling defects?
Indication for tissue plasminogen activator (tPA) in a patient with pulmonary embolism.
Hypotension and systemic hypoperfusion
Which form of childbirth increases risk for pulmonary embolism?
C-section delivery
A patient with a pulmonary embolism can most likely lead to which acid/base disorder? (Hint: what's happening to their total minute ventilation?)
respiratory alkalosis (hyperventilation leads to blowing off too much CO2, leading to alkalosis).
_____ and _____ are two complications of PEs.
What are cor pulmonale and atrial fibrillation/ atrial flutter?
What is an additional test that you could couple with a Wells score to test for DVT/PE?
D-Dimer test.
Hospitalization, supplemental oxygen, anticoagulant, IV fluids and vasopressors, embolectomy, IV fibrinolytics, catheter-directed fibrinolysis.
What is the treatment for UNSTABLE pulmonary embolism?
Where do the majority of thrombi that eventually become pulmonary emboli originate?
they come from the femoral vein or deep leg veins, and then embolize to the lungs (rarely are they formed in the heart or pulmonary vasculature).
What happens in an amniotic fluid embolism?
Amniotic fluid, fetal cells, and fetal debris enter maternal circulation, causing a widespread inflammatory reaction. Occurs during labor or shortly after and is a cause of death after childbirth.
What makes PE particularly difficult to identify?
Most patients have no obvious symptoms at presentation (non-specific symptoms)
Two clinical characteristics that each have a modified Wells score of 1 point.
What are (1) hemoptysis and (2) malignancy?
What is the mechanism of action of tissue plasminogen activator (tPA)?
It binds to fibrin in the thrombus and converts plasminogen to plasmin