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Hematological

Pulmonary embolism is a condition caused by the obstruction of the pulmonary artery or its branches by a thrombus, leading to respiratory symptoms and potential ischemia. Clinical manifestations include dyspnea, tachypnea, chest pain, and may mimic other diseases, with severity depending on the size and location of the embolism. Diagnosis involves a full workup including imaging and blood tests, while management includes anticoagulation for stable patients and consideration of contraindications for unstable patients.

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Jehaziel Abayon
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6 views3 pages

Hematological

Pulmonary embolism is a condition caused by the obstruction of the pulmonary artery or its branches by a thrombus, leading to respiratory symptoms and potential ischemia. Clinical manifestations include dyspnea, tachypnea, chest pain, and may mimic other diseases, with severity depending on the size and location of the embolism. Diagnosis involves a full workup including imaging and blood tests, while management includes anticoagulation for stable patients and consideration of contraindications for unstable patients.

Uploaded by

Jehaziel Abayon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Hematological

Pulmonary Embolism
– Cardio problem with respi symptoms
– Obstruction of the pulmonary artery or one of its branches by a thrombus that originates
somewhere in the venous system or in the right side of the heart
– Causes
– Air embolism (IV)
– Fat embolism (fracture in long bone)
– Amniotic fluid embolism (leakage of amniotic fluid)
– Septic embolism
– Thrombus Formation
– Patho: occlusion of the outflow tract of the main pulmonary artery or the bifurcation (branch)
of the pulmonary arteries - occlusion of blood - ischemia - necrosis
– Patho: occulsion of blood flow - with ventilation, no blood flow - increase alveolar dead space
- no gas exchange - release of substances - vasoconstriction - increase resistance of blood
flow (increaee arterial pressure, increase right ventricular work - right ventricular failure -
drcrease cardiac output - decrease systemic bp - cardiogenic shock - bronchoconstriction -
V/Q mismatch - no gas exchange

Clinical manifestation
– Nonspecific
– Severity depends on size and location
– Ranges from few s/sx to severe
– May mimic other disease
– Dyspnea (most frequent)
– Tachypnea (most frequent)
– Chest pain (sudden snd pleuritic)
– May be substrrnal snd mimic agina
– Anxiety
– Fever
– Tachycardia
– Apprehension
– Cough
– Diaphoresis
– Hemoptysis
– Syncope

Assessment
– full diagnostic workup go rule out other disease
– Xray
– Ecg
– Pulse oximetry
–Abg
–D dimer
–Mdcta (multiple detector ct scan) - gold standard
–pulmonary arteriogram
–V/Q scan
– CXR: Normal/ with infiltrate, atelectasis, elevated diaphragm on affected side, pleural effusion
– ECG
– Sinus tachycardia
– Nonspecific ST-T wave abnormalities
– Abg
– Normal
– Possible hypoxemia
– Hypocapnia
– Mdcta
– Gold standar for pe diagnosis
– Quick
– High quality visualization
– Pulmonary angiography if mdcta not available
– V/Q scan
– Minimally invasive
– Contrast agents
– Evaluates regions of lung
– Compares V/Q percentage
– High sensitivity
Medical Management
Stable:
– normotensive, - hypoxemia
– Immediate anticoaguulatioj
– 10 days
– Long term antiocoag
– 6 mos
– Indefinite
– Initial anticoag
– LMWH - enoxaparin
– UFH - regular heparin
– DOAC
– Direct thrombin inhibitor - dagibatran
– Factor Xa inhibitor - Apixaban
Unstable:
–
Contraindication
– Stroke
– Active cranial
– Active bleeding
– Surgery within 10 days
– Recent labor and delivery
– Trauma
– Severe Hypertension

Notes:
Melana - black
Hemotocizia - fresh blood
Thrombolytics - dissolves blot

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