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Pulmonary Embolism

Pulmonary embolism (PE) is the occlusion of pulmonary circulation caused by various types of emboli, with pulmonary thromboembolism being the focus of this document. Key risk factors include previous clots, older age, and certain medical conditions, while symptoms can range from swelling and pain to shortness of breath and chest pain. Diagnosis involves imaging techniques like CT pulmonary angiography and treatment options include anticoagulation and surgical interventions for high-risk patients.

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24 views15 pages

Pulmonary Embolism

Pulmonary embolism (PE) is the occlusion of pulmonary circulation caused by various types of emboli, with pulmonary thromboembolism being the focus of this document. Key risk factors include previous clots, older age, and certain medical conditions, while symptoms can range from swelling and pain to shortness of breath and chest pain. Diagnosis involves imaging techniques like CT pulmonary angiography and treatment options include anticoagulation and surgical interventions for high-risk patients.

Uploaded by

noureldintamereisa2004
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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PU L M O N A R Y

EM BO L I S M
MMED AB DELKADER
BY : BASMA MOHA
DEFENITION
• OCCLUSION OF PULMONARY CIRCULATION WHICH MAY
CAUSED BY:
1. THROMBI
2. FAT EMBOLI
3. AIR EMBOLI
4. BACTEIAL / SEPTIC EMBOLI
5. AMNIOTIC FLUID EMBOLI
6. TUMOR EMBOLI
AND OUR TOPIC
TODAY IS PULMONARY
THROMBO EMBOLISM
PATHOPHYSIOL
OGY ;
• VIRCHOW’S TRIAD :
• VASCULAR INJURY
• HYPERCOAGULABILITY
• BLOOD STASIS
CLASSIFICATION
RISK FACTORS
PREVIOUS HISTORY OF CLOTS AS DEEP VENOUS THROMBOSIS
 OLDER AGE.
CANCER AND CANCER THERAPY.
 CERTAIN MEDICAL CONDITIONS, SUCH AS HEART FAILURE, CHRONIC
OBSTRUCTIVE PULMONARY DISEASE (COPD), HIGH BLOOD PRESSURE, STROKE,
AND INFLAMMATORY BOWEL DISEASE.
SURGERY AND BED RIDDEN
Symptoms of acute onset
• LL. swelling , pain
• Shortness of breath
• Chest pain (pleuritic, typical]
CLINICAL •
•
Palpitations
hemoptysis
PRESENTAT
ION Signs
• Tachypnea
• Sinus tachycardia
• Hypoxia
• Ll tenderness, hottness , edema
• Shock state and collapse in massive
PE
• DIAGNOSIS OF PE IS MISSED MORE THAN MADE IN THE SAME TIME IT IS ONE OF THE
MOST CAUSES OF UNEXPECTED DEATHES WORLDWIDE.

• ECG ;
SINUS TACHYCARDIA
SIGNS OF RV STRAIN : RBBB , S1Q3T3 , RIGHT AXIS DEVIATION

• ABG ;
MOSTLY ASSOCIATED WITH RESPIRATORY ALKALOISIS ‘ UNLESS SHOCKED PATIENT MAY

DIAGNOSIS
•
BE ASSOCIATED WITH METABOLIC ACIDOSIS ‘
XRAY ;
A NORMAL X RAY DOESN'T EXCLUDE PULMONARY EMBOLISM
SOME SIGNS MAY BE SEEN : WEDGE SHAPED INFARCT , HAMPTON’S HUMP ,
WESTERMARK SIGN , ATELECTATIC BANDS

• CT PULMONARY ANGIOGRAPHY ;
IT IS THE RECOMMENDED IMAGING MODALITY AND THE GOLD STANDARD FOR PULMONARY
EMBOLISM DIAGNOSIS
LABORATORY INVESTIGATIONS
1. D DIMER
2. CBC :
THROMBOPHILIIA
POLYTHYSEMIA

3. CARDIAC ENZYMES :
TROPNONIN
BNP

4. RENAL FUNCTIONS :
CREATININE
UREA

5. COAGULATION PROFILE
6. DIAGNOSIS OF CAUSE [ COLLAGEN PROFILE, THROMBOPHILIA]
COMPLICATIONS
• OBSTRUCTIVE SHOCK AND DEATH
• ARRHYTHEMIA
• RESPIRATORY FAILURE
• PULMONARY HYPERTENSION
• PLEURAL EFFUSION
• COMPLICATIONS OF TREATMENT
• CORPULMONALE
• CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION
DIFFRENTIAL DIAGNOSIS
PE HAS A WIDE DD WHICH MUST BE CONSIDERED

• DD OF ACUTE DYSPNEA WITH OR • DD OF HEMOPTYSIS :


WITHOUT CHEST PAIN: • BRONCHOGENIC CANCER
1. MYOCARDIAL INFARCTION • CONGESTIVE HEART FAILURE
2. PNEUMOTHORAX
3. PULMONARY EDEMA • DD OF PLEURITIC CHEST PAIN
4. AORTIC DISSECTION • PNEUMONIA
5. CARDIAC TAMPONADE • RIB FRACTURE
• PNEUMOTHORAX
• PERICARDITIS
TREATMENT
PROPHYLACTIC : THERAPUTIC :

• IF THE PATIENT IN HIGH RISK “SHOCKED” : REPERFUSION


MUST BE DONE
A- ELECTIVE ANTI COAGULATION MEDICALLY BY THROMBOLYTIC THEARPY OR

B-ELASTIC STOKING SURGICALLY BY CATHETER DIRECTED THERAPY OR PULMONARY


END ARTERIECTOMY “IF MEDICAL TTT IS CONTRAINDICATED “
C- EARLY POST OPERATIVE
AMBULATION
D-ELECTRIC STIMULATION OF CALF • IF THE PATIENT IS NON HIGH RISK PATIENT :
MEDICAL TREATMENT BY ANTICOAGULANT AGENTS “
MUSCLES BY GALVANIC CURRENT
UNFRACTIONATED HEPARINE , LMWH , OACS “

• SURGICAL TREATMENT BY IVC FILTER FOR RECURRENT


THROMBOEMOLISM
THANK YOU

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