Published on: Mar 4, 2016
Transcripts - polmunary embolism(kwrdistan)
A pulmonary embolism (PE) is a life-
threatening condition where a blood clot
begins to move through the vessels of the
body and lodges in an artery in the lungs. In
some cases, multiple clots (emboli) can move
to the lungs.
EmbolismAn embolism - from the
Greek émbolos meaning "stopper" or "plug" -
is the term that describes a condition where
an object called an embolus is created in one
part of the body eg. Polmonary
embolism,Brain embolism, Retinal embolism,
Amniotic embolism, air ambolism,
Thromboembolism , cholestrole embolism ,
Fat embolism, Septic embolism , Foreign
1. Fat Emboli
2. Air Emboli
3. Amniotic Fluid Emboli
4. Thrombus (Clot Emboli)
5. Septic embolism
6. Forigin body embolism
7. Septic embolism
circulatory condition characterized by a plug of fat blocking
an artery. The plug enters the circulatory system after the
fracture of a long bone or traumatic injury to adipose tissue
or to a fatty liver. Fat emboli are the result of the release of
free fatty acids, causing a toxic vasculitis, followed by
thrombosis, and obstruction of small pulmonary arteries by
fat. Usually occurs within 12-36hrs after an injury.
o multiple fractures
o Patients 10 – 39 years old
o Trauma to adipose tissue or liver
o Sickle cell c
the abnormal presence of air in the CV system resulting in
obstruction of blood flow. May occur if large quantity of
air is inadvertently introduced by injection (as during IV
therapy or surgery) or by trauma (puncture wound)
o Any surgical procedures that can lead to
infusion of air
o Creation of a pressure gradient of air entry (ex.
Lumbar punctures, peripheral IVs, central
venous catheter, etc.)
o Positive pressure ventilation (during mechanical
ventilation or scuba diving)
o Blunt & penetrating trauma to the chest,
abdomen, neck, or face can lead to entry of air
Amniotic Fluid Emboli (AFE):
occurs when amniotic fluid is drawn into the maternal
circulation and carried to the woman’s lungs. Fetal
particulate matter (skin cells, vernix, hair, and
meconium) in the fluid obstructs pulmonary vessels.
Failure of the right ventricle occurs early and can lead
to hypoxemia. Left ventricle failure follows
o medical induction of labor,
o cesarean section or operative vaginal delivery,
o placenta previa, and
o cervical laceration or uterine rupture
a condition in which a blood vessel is obstructed by a thrombus
carried in the bloodstream from its site of formation. The area
supplied by an obstructed artery may tingle & become cold,
numb, and cyanotic. Thrombi can result from blood stasis,
alterations in clotting factors, and injury to vessel walls.
A-fib, heart failure/MI, rheumatic heart disease
Prolonged surgery (longer than 30min)
Age > 55y/o
In the vast majority of cases, a pulmonary
embolism is caused by another type of blood
clot, called a deep vein thrombosis or DVT. A
deep vein thrombosis typically forms in the veins
of the legs. These clots can start to move until
they lodge in a vessel that is too small to allow
the clot to move any further, typically the small
arteries of the lungs.
Breaking a bone
Blood clotting disorders
History of previous blood clots
History of previous pulmonary embolism
Pregnancy or Recent Pregnancy
Birth control pills
A pulmonary embolism can present signs and
symptoms that range from barely notable to
severe. In fact, some patients only notice the
signs of the deep vein thrombosis that led to
the pulmonary embolism and not the
embolism itself. For this reason, the signs
and symptoms of deep vein thrombosis that
may seem unrelated to a lung condition, such
as calf pain, are included in this list.
Difficulty breathing (dyspnea)
Coughing up blood-tinged sputum
Shortness of breath
One leg that is larger than the other (typically the
calf of one leg is swollen)
Clammy or sweaty skin
Rapid heartbeat (tachycardia)
ABGs levels show respiratory alkalosis and
• Pulmonary angiography shows location of
embolism and filling defect of pulmonary
• Physical findings: clinical signs and
• Chest X-ray shows dilated pulmonary
arteries, penumoconstriction, diaphragm
elevation on the affected side.
• Radioisotope lung scan.
The course of treatment for a pulmonary
embolism varies based upon the severity of
the embolus, the cause of the embolus, the
number of emboli present, the general
health of the patient and any medical
condition that may affect the outcome of
Although both drugs decrease fibrin formation,
they do so by different mechanisms:
Heparin inactivates thrombin and factor Xa, whereas
warfarin inhibits synthesis of clotting factors.
Effects of heparin begin and fade rapidly,
whereas effects of warfarin begin slowly but
then persist for several days.
Different tests are used to monitor therapy:
PT is used to monitor warfarin: Normal range for the
PT is between 10 and 13 sec.
aPTT is used to monitor heparin: Normal range for
aPTT is between 28 to 34 sec.
Vitamin K is given to counteract warfarin
whereas protamine is given to counteract
There are multiple ways to remove blood
clots, ranging from minimally invasive
procedures that are done by inserting tiny
instruments into blood vessels and threading
them through the vessel to the clot, to an
emergency surgery to remove the clot.
Known by a variety of names, including
Inferior Vena Cava Filter, IVC, and Greenfield
Filter, this is a tiny filter that is surgically
placed in the large blood vessel that returns
blood from the body to the heart. This filter
is designed to "catch" tiny blood clots before
they are circulated through the heart and on
to the lungs. Most often, these filters can be
placed using minimally invasive techniques.
Thrombolytic drugs such as streptokinase
or tissue plasminogen activator (TPA) break up
and dissolve blood clots.
Thrombolysis is more expensive than
anticoagulant therapy and is associated with a
higher risk of bleeding, so its use should be
restricted to patients who are likely to benefit
They can be used for people who appear to be in
danger of dying of pulmonary embolism.
However, except in the most dire situations,
these drugs cannot be given to people who have
had surgery in the preceding 2 weeks, are
pregnant, have had a recent stroke, or tend to
A rare procedure where a clot is surgically
removed from the pulmonary system
Preoperative angiography must be done to
find and confirm the pulmonary embolism
An emergent embolectomy may be indicated
for a patient with a severe obstruction who
did not respond to the usual therapy
IVC filter is placed after embolectomy
Lewis et al. mentions the mortality rate of
the procedure is 50%.
Most people with a PE are treated successfully
and do not get complications. However, there
are some possible, serious complications and
Collapse - due to the effects of the blood clot on
the heart and circulation. This can cause a
cardiac arrest where the heart stops, and may
The PE can cause a strain on the heart. This may
lead to a condition called heart failure, where
the heart pumps less strongly than normal.
Blood clots can occur again later (known as a
recurrent PE). Anticoagulant treatment helps to
Complications due to treatment. The anticoagulant
treatment can have side-effects. The main one is
bleeding elsewhere in the body - for example, from a
stomach ulcer. About 3 in 100 patients will get
significant bleeding due to anticoagulant treatment
for a PE. Usually this type of bleeding can be treated
successfully. This type of bleeding can (rarely) be
fatal (in about 3 in 1,000 cases of PE). However, it is
almost always safer to take the anti-clotting
treatment than not to, so as to prevent another PE
which could be serious.
If there are repeated small PEs, they may (rarely)
contribute to a condition where there is high pressure
in the lung blood vessels (called primary pulmonary
For any hospital patient, DVT prevention and risk reduction are
essential nursing goals. Whenever possible, only minimal
sedation, if any, should be used as a way to keep patients more
active. Neuromuscular blocking agents should be avoided because
they’ve been linked to DVT. Use of sedation scales may provide a
more consistent approach to sedation dosing, as might sedation
and analgesia protocols.
Implementing and maintaining prophylactic measures as a
standard practice for preventing DVT are essential. Protocols for
ventilator management and weaning also may be crucial to
restoring activity levels and liberating patients from mechanical
Make sure you’re familiar with DVT and PE risk factors and signs
and symptoms. Be aware that when PE is confirmed or strongly
suspected, treatment must begin immediately. Be sure to
monitor patients for pain, anxiety, and anticoagulant side effects
(such as bleeding), and provide appropriate interventions.
Graduated compression stockings.
Prevention while traveling
Take a break from sitting.
Fidget in your seat.
Drink plenty of fluids.
Wear support stockings.
Impaired gas exchange R/T altered oxygen
supply S/T ventilation perfusion mismatch.
Acute Pain R/T inflammatory process caused
by thrombus formation.
Risk for injury R/T hypercoagulable state.
Ineffective protection R/T prolonged
bleeding S/T anticoagulation therapy.
Anxiety R/T pain and intrusive diagnostic and
surgical tests and procedures.
Bed rest with active and passive range of motion.
– Keep the patient with fowler position to enhance
– Assist with turning, coughing, and deep breathing to
mobilize secretions and clear airway.
– Assess respiratory status to detect respiratory
– Assess cardiovascular status. An irregular pulse may
signal arrhythmia caused by hypoxemia. If cause of PE
by thrombophlebitis, temperature may be elevated.
- Administer O2 to enhance oxygenation.
– Establish an IV line for fluids and drugs.
– Monitor and record intake and output to
detect fluid volume overload and renal
– ABGs monitoring to evaluate the need for
– Monitor laboratory studies because patient
on heparin and need to evaluate electrolyte,
CBC and Hct
_MONITORING FOR COMPLICATIONS
_PROVIDING POSTOPERATIVE NURSING CARE
_PROMOTING HOME AND COMMUNITY-BASED CARE
-MINIMIZING THE RISK OF PULMONARY
-PREVENTING THROMBUS FORMATION
-ASSESSING POTENTIAL FOR PULMONARY
-MONITORING THROMBOLYTIC THERAPY
How does a Pulmonary Embolus cause
Hypoxemia? Hypoxemia is a deficient
oxygenation of the blood. A pulmonary
embolism is a sudden blockage in a lung
artery, most often caused by a traveling
blood clot from a vein in the leg. These clots
are formed via the condition of deep vein
thrombosis. A pulmonary embolism brings
about lung tissue damage, hypoxia and other
organ impairment as a result of your blood’s
hypoxic state. Death can ensue
What are the signs and symptoms of a
What are the four major types of pulmonary
Are Pulmonary embolisms usually single or