PULMONARY EMBOLISM

Pulmonary Embolism

Shawnee Payne

Nursing Department, Utah Tech University

Lifespan II

Prof. Dean Brereton

February 21st, 2023

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To understand what a pulmonary embolism is in its entirety, it is important to understand

what deep vein thrombosis is, as they are interconnected. It is also important to know about the

onset and presenting symptoms of a pulmonary embolism, as well as diagnostic testing,

treatments, prevention, and prognosis that will later be discussed.

A deep vein thrombosis, also referred to as a DVT, is a clot of blood formed deep in the

vein. It most often occurs in the legs, but can occur in other extremities as well. There are a

number of different causes, but are most commonly due to slowed or blocked blood flow. DVT’s

can result from things such as an injury, excessive inflammation, or infection. The blocked or

slowed blood coagulates in the veins, and becomes lodged within the walls then a clot forms.

DVT’s cause various issues when lodged within the vascular system, but can also be life

threatening if they break off and form a pulmonary embolism. These emboli are dangerous

because they break off and travel back up the body, where they get caught in the small vessels of

the lungs and cut off blood flow (John Hopkins Medicine, 2021). Many signs and symptoms may

or may not arise, which will be discussed later, and can sometimes cause death. These are the

most common types of pulmonary embolisms as they occur in about 80% of patients with DVT,

although they may not always stem from a deep vein thrombosis.

Other types of pulmonary embolisms can include a fat embolism that occurs when small

pieces of fat get caught in blood vessels and cause blockages. These often occur because of

trauma such as orthopedic surgery, bone breaks or fractures, and even liposuction. Common

causes such as those release little pieces of fat which then travel through the vascular system and

get trapped in the smaller blood vessels such as the capillaries of the lungs. Fat embolisms

present with various signs and symptoms throughout the body.

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Onset and Presenting Symptoms

Pulmonary embolisms may go unnoticed in some cases but may present various signs and

symptoms in others. Some of the most common symptoms of a PE include shortness of breath,

tachypnea, tachycardia, chest pain, coughing up blood, lightheadedness, dizziness, fainting, and

blue lips or nails (John Hopkins Medicine, 2021). Most of which are due to the emboli getting

caught in the capillaries of the lungs and inhibiting proper blood flow and oxygenation to the rest

of the body.

Fat embolisms may present with other signs and symptoms such as tachypnea,

tachycardia, change in mental status, agitation, or a petechial rash. Petechiae are small red spots

that may appear all over the body. They are thought to be caused by post obstructive hemorrhage

that causes damage to the capillaries . They are commonly found on the conjunctiva, oral

mucous membranes, and skin (Kwiatt, 2013).

Diagnostic Testing

There is not one single test that confirms the presence or absence of a pulmonary

embolism, instead it is more reasonable to conduct multiple tests in order to rule out or rule in

what the cause may be. The most common methods of diagnosis for a pulmonary embolism

include a D-dimer test, CTPA, V/Q scan or X-Ray.

D-dimer is used to rule out other speculated causes. This test takes a blood sample and

checks for issues with blood clotting. It works by measuring a protein that is released by the

body when a blood clot dissolves. A positive result means your body may be making clots. A

CTPA (CT Pulmonary Angiogram) is a test that looks for blood clots in the vessels within the
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lungs. Dye is injected into the vascular system and will show up on scans as a bright white area.

This test is contraindicated in patients that are allergic to iodine. A V/Q scan is another kind of

test that is used to diagnose a pulmonary embolism. It stands for a ventilation/perfusion scan. A

small amount of radioactive tracer is used and it shows how well or how poor circulation of air

and blood is within the patient's lungs. It also tracks where in the body blood is flowing to. If the

ventilation and perfusion scans don't match, it may be indicative of a pulmonary embolism

(Kline, 2000). X-Rays are another common test used. They may not be able to detect if a

pulmonary embolism exists, but rule out other possible concerns with similar symptoms.

Treatments

Treatments of a pulmonary embolism include maintaining cardiovascular and pulmonary

function, oxygenation and use of anticoagulant and thrombolytic medications. Anticoagulant

medications help prevent any additional blood clots from forming and help prevent any existing

clots from getting larger. An example of this kind of treatment would be Heparin or Warfarin.

These drugs should be taken with caution. One of the major side effects includes bleeding since

these drugs stop the blood from clotting. Thrombolytic medications are used to break down

existing clots. These work by activating plasminogen that breaks down fibrin blood clots. (Baig,

2022) Taking thrombolytic medication should also be used with caution as they interfere with

coagulation and increase risk of bleeding. The lengths of treatment depends on the underlying

cause, it can range anywhere from three months to being lifelong.

Surgery is another option for treatment. Thrombectomies are surgical procedures where a

catheter is inserted into the blood vessels and used to thin or suction out blood clots. This type of

surgery can also include the use of thrombolytic medication to assist in the removal. Pulmonary
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thrombectomies work best when the clot is located in the larger blood vessels in the lungs such

as the pulmonary arteries (Sobieszczyk, 2012).

Nonpharmacological treatments consist of early ambulation, compression

stockings, and bedrest. Early ambulation is used in patients that are more stable and should not

be used in patients that have a significant PE. Ambulation is gradually increased and can help

strengthen the patient. It also helps prevent stasis of blood, therefore reducing the risk of clot

formation. Compression stockings help to reduce swelling and improve circulation in the legs.

The constant pressure is resistant to allowing blood to pool in the lower extremities and increases

circulation by assisting fluids back up towards the heart to then be recirculated. Bed rest is

important in those that actively have a DVT and in the prevention of it breaking off and forming

an emboli. Best rest is usually used in combination with anticoagulants or thrombolytics to break

up the existing clot and prevent new ones from forming.

Prevention

PE is the third most common cause of hospital related deaths, but it is preventable.

Common methods of preventing a pulmonary embolism include use of compression stockings,

cessation of smoking, frequent exercise, avoid sitting for long periods of time or crossing legs,

staying hydrated, keeping a healthy weight and maintaining a healthy diet (John Hopkins

Medicine, 2021). All of these things are important for helping to maintain adequate perfusion

and movement of blood throughout the body. Before surgeries, doctors may prescribe

anticoagulants to patients that are at higher risk of clotting in order to help prevent blood clots

from forming.
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Prognosis

Prognosis of a pulmonary embolism depends on the situation and may vary. Although

pulmonary embolisms may pose a huge risk and can be life threatening, the majority of patients

survive if diagnosed and treated promptly. Patients with a PE are at highest risk in the first week

of occurrence (Eichinger, 2004). Some early events that may occur include shock, stroke,

worsening oxygenation, respiratory failure, and pneumonia. Later events include death,

recurrence, pulmonary hypertension, and right ventricular dysfunction.

Pulmonary embolisms occur when circulation in the body is poor or inhibited which

leads to the formation of a clot. This clot can break off from the vessel walls and travel to the

lungs. Patients with a PE may or may not experience symptoms. It is important to seek early

diagnosis and intervention, as PE may be fatal. The most common tests used include the

D-Dimer, CTPA, and V/Q scan. Treatment options vary depending on the situation but most

likely consist of anticoagulants, thrombolytics, and in extreme cases surgery. PE is a preventable

disease and is prevented by maintaining proper cardio and pulmonary function, as well as

healthy lifestyle changes. Patients experiencing PE symptoms should seek help immediately. The

more time that passes without intervention, the risk of complications and death increases.
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References

Baig, M. U., & Bodle, J. (2022). Thrombolytic Therapy. StatPearls.

Eichinger S, Weltermann A, Minar E, et al. (2004) Symptomatic Pulmonary Embolism and the
risk of recurrent venous thromboembolism. Arch Intern Med. 164(1) 92–96.
doi:10.1001/archinte.164.1.92 (Level V)

Johns Hopkins Medicine. (2021). Pulmonary Embolism . Health conditions and diseases.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/pulmonary-embolism

Kline, J., Johns, K., Colucciello, S., & Israel, E. (2000) New diagnostic tests for pulmonary
embolism. Annals of emergency medicine. 35(2) 168-180
https://doi.org/10.1016/S0196-0644(00)70137-5. (Level 1)

Kwiatt, M. E., & Seamon, M. J. (2013). Fat embolism syndrome. International journal of critical
illness and injury science, 3(1), 64–68. https://doi.org/10.4103/2229-5151.109426

Sobieszczyk, P. (2012) Catheter-assisted pulmonary embolectomy. American heart association.

126(15), 1917-1922. https://doi.org/10.1161/CIRCULATIONAHA.110.963041