Mod 2-5 Pulmonary Embolism Flashcards
Pulmonary embolism is a potentially ________ condition.
fatal
What is the most common pathologic process involving the lungs of hospital patients?
Pulmonary embolism
Pulmonary embolism is the ____ most common cause of death in hospitalized patients. How many annually?
third; 650,000
Approximately what percentage of patients have died in the hospital had pulmonary embolism? Of those, what percentage had missed diagnosis?
60%; 70%
What is the definition of an embolus?
intravascular mass that may be composed of air, fat or solid material that is carried by the blood to a site other than its origin.
Over ___% of emboli begin as a thrombus.
98%
What is a thrombus?
A blood clot that becomes an embolus when it moves through the circulation.
What does an emboli of arterial origin usually affect?
The legs or brain or other organ in the body and usually causes an infarction (tissue death).
What does an emboli of venous origin usually affect?
Lungs and may or may not cause pulmonary infarction.
Where does most emboli arise from?
Deep veins of a lower extremity site (calf or thigh) where blood platelets have attached to a venous valve.
What four things encourage the development of deep vein thrombosis in the lower extremity?
1) Venous stasis from bed rest or during a major operation.
2) Injury to the inner lining of a vein.
3) Hyperclotting state
4) Previous embolus
Why are elderly patients particularly subject to pulmonary embolus?
1) Reduced activity levels caused by a number of reason such as conditions that require extended amounts of bedrest or surgery creating predisposition to embolus.
2) Some cancer cells may produce agents that increase the formation of clots.
3) They have experienced a MI or a stroke and have had a previous clot which predisposes another clot.
What percentage of PE’s arise in the deep vein of the legs?
95%
As a clot detaches itself from a venous site, where does it pass through?
Passes through inferior vena cava, right atrium, right ventricle, main pulmonary artery, right or left lung until it can no longer go further.
What percentage of clots are of such a large size that they will occlude the pulmonary artery itself or lodge where ether artery bifurcates?
5%
Describe the vast majority of emboli.
Small and accompanying symptoms are very hard to diagnose.
What sites may be affected by PE?
- Major pulmonary artery or site of bifurcation artery (5%/)
- More distal arterial sites (up to 80%)
Symptoms of PE are easily diagnosed from clinical symptoms and are specific. T/F?
False
*Not easily diagnosed and symptoms are often vague and non-specific.
Clinical manifestations are absent or inconclusive in about ___% of patients.
80%
What is the classical clinical appearance of PE?
Cough with hemoptysis (blood), dyspnea and pleuritic chest pain.
*Hemoptysis occurs only in the minority of patients.
What percentage of patients display classic clinical manifestations of PE?
20%
Why is it that older patients may not have chest pain?
Because of altered pain sensation or it may be mistaken for pain of angina.
Cough is present in less than ___% of patients.
50%
*But is non-specific and attributed to any number of chest problems from TB to respiratory allergies.
What are some clinical signs of PE?
Palpitations, increased heart rate, wheezing, cyanosis, elevated temperature.
