Overview Pulmonary embolism occurs most often from a dislodged thrombus from the lower limb (DVT). The embolus travels towards the lung and becomes lodged in the pulmonary artery resulting in infarction of the lung tissue.
Deep Vein Thrombosis (DVT): Blood clot in the deep venous system that usually affects the lower extremities or pelvic veins.
Pulmonary Embolism usually arise from Deep Vein Thrombosis (DVT). DVT is the most common in patient over 40 years of age who undergo major surgery.
|Remember Genetic predisposition to hypercoagulability accounts for approximately 20% of PEs. The most common inherited conditions are the factor V Leiden mutation and the prothrombin gene mutations
Clinical Presentation Most patients with PE experience dyspnea commonly without other symptoms. Syncope, cyanosis, angina are signs of massive PE. Unilateral pleuritic chest pain is experiences in minority of patients +/- haemoptysis. Signs and risk factors for DVT is extremely important during history and examination.
|Remember Always suspect pulmonary embolism (PE) in sudden collapse 1-2weeks after surgery
PE is incorrectly diagnosed in almost 75% if patients. Acute onset of dyspnea or hypoxemia with a normal chest x-ray should be considered a pulmonary embolism until proven otherwise.
|Remember Normal INR is 1. Therapeutic range for people on warfarin INR 2-3
Emergency Pulmonary Embolism If patient is haemodynamically unstable, emergency pulmonary embolectomy should be considered. In patients with large PE and no contraindications, thrombolysis is the definitive management.
|Video: Pulmonary Embolism Overview