pulmonary embolism Flashcards
Describe what a pulmonary embolism is
An obstruction of the pulmonary artery or one of its branches by material that originated somewhere else in the body
What material can cause a pulmonary embolism?
Blood clot
Air embolism
Tumor fragments
Fat
Amniotic fluid
Describe why the location of a pulmonary embolism is so important
The location of the embolism determines how much of the lung or lungs are not receiving arterial blood. An embolism that cuts off blood flow to a small portion of a lobe is much less significant than an embolism that cuts off circulation to both lungs
What is the most dangerous type of embolism?
A saddle embolism
A pulmonary embolism can lead to infarction. What can this result in?
Alveolar atelectasis
Alveolar consolidation
T/F: Advances in modern imaging have resulted the discovery of PE that would have otherwise gone undetected
True
A pulmonary embolism can sometimes cause an inflammatory response. What can this lead to?
Bronchospasm
Seems to contribute to shunt like effect on top of PE deadspace for total effect of hypoxemia
What is the incidence of PEs in the US?
38 cases per 100000 annually
100,000 deaths annually
How does decreased perfusion affect surfactant production?
Decreases surfactant production
What are the effects of decreased surfactant production as a result of a PE?
Decreased lung compliance
Atelectasis
V/Q mismatch
What is thrombophlebitis?
Condition where a blood clot forms and blocks venous return, usually in the legs but it can occur throughout the body
How does bone cancer increase the risk for a PE?
Bone cancers can lead to pathological fractures, the fractures can allow bone marrow to escape into blood stream, boom. PE
Why are women who are pregnant at an increased risk of PE?
Enlarged uterus can result in obstruction of venous return resulting in stagnant blood that can form clots
What pathological malignancies increase risk for PEs?
Multiple myeloma (bone cancer)
Tumors
How do tumors increase the risk for PE?
Potential fragmentation into bloodstream
Tumor can release procoagulant factors
Why are patients in the hospital at an increased risk for developing a PE?
They are immobilized
Potentially hypercoagulable states
Frequently have undergone major surgery
What other factors and conditions can increase risk of a PE?
Obesity
Childbirth
Supplemental estrogen
Family history of venous thromboembolism
Smoking
Burns
Pacemakers or venous catheters
What can lead to hypercoagulation?
Oral contraceptives
Polycythemia (increased RBC count)
Factor V leiden (genetic disorder that increased chances of forming clots)
Where do most clots form?
Most clots originate or break away from sites of deep venous thrombosis in the lower part of the body
Leg, pelvic veins, inferior vena cava
What is venous stasis and how does it contribute to clot formation?
Slowing or stagnation of blood flow through the veins
Stagnating blood has a higher risk of coagulation
What hemodynamic indices would we see on a PE patient who is crashing?
Decreased CO
Systemic hypotension
Increase PVR
How does injury to the endothelial cells increase the risk for clot formation?
Activation of the platelets to form a clot which can then break off
How would a patient who is crashing as a result of PE present?
Sudden onset of dyspnea, tachycardia and hypotension
Hypotension
Weak pulse
lightheaded/fainting
Anxiety
Cyanosis
Describe chest pain that is caused by a PE
May be pleuritic
May radiate
Can be sharp, stabbing, aching or dull
May intensify with exertion
Does not subside with rest
Describe the sputum that a patient with severe PE might produce
Bloodstreaked
T/F: a patient in critical condition with a PE may produce a wheeze
True
Describe how septic emboli form and what can happen as a result of their formation
Vegetations form on the tricuspid or pulmonary valve in the heart
Vegetations fragment and lodge themselves in pulmonary arteries
Vegetations fragment causing infections, abscesses, cavities and infarcts, oh my!