Pulmonary Embolism

Question 1

what is an embolus?

Answer 1

foreign component that mobilizes in blood vessel could be air or neoplastic cells or moving blood clot

Question 2

what is a thrombus?

Answer 2

-blood clot

Question 3

pulmonary has a _______ mortality rate

Answer 3

greater than 30% mortality rate and this is dictated by size of embolus, if small embolus obstructs small vessel, if large obstruct in large vessel causing serious damage

Question 4

pulmonary embolism has an approx _____% recurrence

Answer 4

approx 10% recurrence

Question 5

what is pulmonary embolism

Answer 5

a thrombus in pulmonary vessel

Question 6

what is the etiology (cause) of pulmonary embolism?

Answer 6

-usually from DVT
others are:
-Fat embolus 
-air
-amniotic fluid

Question 7

where do DVT’s usually from? in what veins

Answer 7

usually in limbs

vein: iliac, popliteal, femoral

Question 8

what does DVT stand for?

Answer 8

deep vein thrombosis

Question 9

what usually causes a fat embolus with then causes pulmonary embolism?

Answer 9

a fracture,
the fracture severs blood vessel, bone is richly vascularized when you fracture bone, blood vessel is severed, there is a substantial amount of fat in bone marrow which then gets into circulation

Question 10

how does amniotic fluid cause pulmonary embolism?

Answer 10

during a delivery,
amniotic space membrane will severe & blood vessel will sever, particular components of amniotic fluid enter circulation, causes platelet agglutination then embolus forms

Question 11

what is the patho of pulmonary embolism?

Answer 11

• DVT
• becomes an embolus
• thrombus in arterial bed
• decreased perfusion when embolus becomes stationary, platelets immediately come & send out mediators to invite other platelets, these mediators also affect mucus in airway causing

Question 12

what are the manifestations of pulmonary embolism? and what are they based on?

Answer 12

• based on size & site
• usually dyspnea, tachycardia (increased RR), chest pain
• tachycardia (compensatory mechanism from decreased cardiac ouput)

Question 13

Diagnosing Pulmonary embloism?

Answer 13

• Hx, Px
• ABGS
• D-Dimer: when blood has clotted,fibrinolysis and a by product is D-dimer, which will be measured in pulmonary embolism, DVT, clotting disorders, after surgery, DIC (disseminated intravascular disorder)
• LDH3: Lactate dehydrogenase an enzyme in lung tissue, when a cell is damaged it releases its contents, so when lung is damaged this is released and elevated in the blood
• Lung scan (131 I-HSA, IV): Isotope, Iodine-Human serum albumin, label albumin which have alot of in blood, take label with iodine and introduce in circulation, movement will occur until hit an obstruction not exact as pulmonary angiogram
• pulmonary angiogram (very invasive)
• CT chest

Question 14

treatment of pulmonary embolism?

Answer 14

• stat treatment equals increased prognosis
• thrombolytics & anticoagulants (prevent clot & stop party-platelet agglutination)
• Maintain cardiopulmonary function
• deal with underlying cause, most cases DVT

Question 15

when blood has clotted you break up fibrin(called fibrinolysis) what is a by-product of this?

Answer 15

D-dimer

Question 16

what is Lactate dehydrogenase?

Answer 16

lactate in dehydrogenase is an enzyme in lung tissue when cell is damaged release contents, so when lung is damaged this is released and elevated in the blood