Pulmonary embolism

• Associated with hyper-coagulation state (protein C and S deficiency ),

trauma, prolonged bed rest
• High M&M
• Pathophysiology:
o Pulmonary arteries obstruction → ↑ dead space ventilation →
hypoxemia , hypercarbia
o ↑ PVR, Bronchospasm
o RV dysfunction and arrhythmias
• Pt may present to the OR for emergency surgery, insertion of IVC filter or
surgical embolectomy
• Also Pt may present with previous history of PE, and now anticoagulated →
have a hematology consult (Q: risk/benefit of holding meds pre-op) also
discuss with the surgeon regarding continuing the anticoagulation med peri-
op
• Have PT, PTT, and PLT count (HIT)
• Better to avoid Neuraxial technique in those Pt
• If diagnosis is in doubt → Spiral CT, V/Q scan, Echo
• S/S → SOB, syncope, hemoptesis, tachypnea, fever
• P/E → look for S/S of RV failure and pul HTN
• Consider pneumatic compression device, and elastic stocking peri-op
• IVC filter can be done under LA
• GA:
o Art-line, CVP, PAC??, TEE
o Have inotrops support ready
o Avoid myocardial depressant drugs
o Avoid things that may ↑ PVR→ hypoxia, ↑PCO2, acidosis,
hypothermia
o Look for ↓ ETCO2, ↑ PCO to ETCO2, hypoxemia