Pulmonary Embolus

Pulmonary embolus (PE) is caused by an obstruction of flow in the pulmonary arteries due to arterial occlusion. This occurs most commonly from the embolization of blood clots from the deep veins of the legs (the subject for the following discusion). Fat after long bone fractures), air, amniotic fluid, blood clots from other locations, and other substances are rare causes or PE. At least one of the following risk factors is present in 90% of patients with PE: immobility, heart disease, cancer, estrogen therapy, previous deep venous thrombosis (DVT) or PE, hypercoagulability, or abnormal thrombolysis. Not all patients with cancer or hypercoagulability are known at the time of presentation.

Causes

• It may be caused by clots from the venous circulation, from the right side of the heart, from tumours that have invaded the circulatory system, or from other sources such as amniotic fluid, air, fat, bone marrow, and foreign substances.
• Several factors that may caused pulmonary embolus including prolonged bed rest or inactivity including long trips in planes, cars, or trains, oral contraceptive use, surgery especially pelvic surgery, childbirth, massive trauma, burns, cancer.

Symptoms

• Chest pain ++++ (two thirds of patients with chest pain describe pleuritic pain)
• Dyspnea ++++
• Cough +++
• Hemoptysis ++
• The classic triad of dyspnea, pleuritic chest pain, and hemoptysis is seldom present ++
• Syncope ++

Signs

• Tachypnea> 16/min ++++
• Rales +++
• P2 >A2 +++
• Tachycardia +++
• Fever (low grade) +++
• Diaphoresis +++
• Hypotension (in massive PE)
• Hypoxia (by pulse oximetry)
• Pleural friction rub
• Evidence of DVT (calf swelling-one calf with circumference 2 cm greater than opposite calf) ++

Treatment

• For the treatment of Pulmonary Embolus, the emergency treatment and hospitalization are necessary. Because in cases of severe, life-threatening pulmonary embolism, definitive treatment consists of dissolving the clot with thrombolytic therapy. Anticoagulant therapy prevents the formation of more clots and allows the body to re-absorb the existing clots faster.
• In which thrombolytic therapy, it includes streptokinase, urokinase, or t-PA.
• In anticoagulation therapy, it consists of heparin by intravenous infusion initially, then oral warfarin (Coumadin). Subcutaneous low-molecular weight heparin is often substituted for intravenous heparin in many circumstances.
• In patients who cannot tolerate anticoagulation therapy, then inferior vena cava filter may be placed. This device, placed in the main central vein in the abdomen, is designed to block large clots from traveling into the pulmonary vessels. Oxygen therapy may be required to maintain normal oxygen concentrations.