Pulmonary

Embolism
BY ODINAKA EDEBEATU
 Pulmonary embolism
(PE)
 refers to the obstruction of the
pulmonary artery or one of its
branches by a thrombus (or
thrombi) that originates somewhere
in the venous system or in the right
side of the heart
 Cause
 1.thrombous s
 2. embolism
 3.trauma
 4. surgery
 5. hypercoaguability
 6. heart failure
 7. pregnancy ( increase coaguability of
BL
 8. older than 50 years
 9. atrial fibrillation
 Pathophysiology
 -When a thrombus completely or
partially obstructs a pulmonary artery or
its branches,
 the alveolar dead space is increased.
The area, although continuing to be
ventilated, receives little or no blood
flow. Thus, gas exchange is impaired or
absent in this area.
 Pathophysiology
 -In addition, various substances are
released from the clot and surrounding
area, causing regional blood vessels
and bronchioles to constrict.
 This causes an increase in
pulmonary vascular resistance. This
reaction compounds (the ventilation–
perfusion imbalance.)
 Pathophysiology
 -The hemodynamic consequences are
increased pulmonary vascular resistance
from the regional vasoconstriction and
reduced size of the pulmonary vascular
bed.
 This results in an increase in pulmonary
arterial pressure and, in turn, an
increase in right ventricular work to
maintain pulmonary blood flow. When
 Pathophysiology
 the work requirements of the
right ventricle exceed its
capacity,

right ventricular failure
occurs, leading to a decrease
in cardiac output followed by a
decrease in systemic blood
pressure and the development
of shock.
 RISK FACTORS
 Venous Stasis (slowing of blood flow in
veins)
 -Prolonged immobilization (especially
postoperative)
 -Prolonged periods of sitting/traveling
 -Varicose veins
 -Spinal cord injury
 -Hypercoagulability (due to release of tissue
thromboplastin after injury/surgery)
 -Injury
 -Tumor (pancreatic, GI,, breast, lung)
 -Increased platelet count (polysalathemia,
splenectomy
 RISK

- Venous FACTORS
Endothelial Disease
 -Thrombophlebitis -Vascular disease
 -Foreign bodies (IV/central
venous catheters)
 -Certain Disease States
(combination of stasis,
coagulation alterations, and
venous injury)
 -Heart disease (especially heart failure)
 -Trauma (especially fracture of hip,
pelvis, vertebra, lower extremities)
 RISK

FACTORS
-Postoperative state/postpartum period
 -Diabetes mellitus
 -Chronic obstructive pulmonary disease
c op D
 -Other Predisposing Conditions
 -Advanced age -Obesity -Pregnancy
 -Oral contraceptive use
-Constrictive clothing
 -History of previous
thrombophlebitis, pulmonary
 Clinical Manifestations
 1.Dyspnea is the most frequent
symptom; tachyapnea (very rapid
respiratory rate) is the most frequent
sign . The duration and intensity of the
dyspnea depend on the extent of
embolization. Chest pain is common
and is usually sudden and pleuritic. It
may be substernal and misdiagnosed
with angina pectoris or a myocardial
infarction.
 - Other symptoms include anxiety,
fever, tachycardia, apprehension,
cough, diaphoresis, hemoptysis, and
 Assessment and
Diagnostic
 Findings
-The diagnostic workup includes a
 - ventilation–perfusion scan,
 -pulmonary angiography,
 -chest x-ray
 -, ECG,
 -peripheral vascular studies, and
arterial blood gas analysis.
 -Doppler ultrasonography and
venography
 Prevention
 prevent deep venous thrombosis.
 1. active leg exercises
 2. The intermittent pneumatic leg
compression device ( reduces
venous stasis).
 3. use of elastic compression
stockings
 4. anticoagulant therapy
 Medical Management
 • General measures to improve
respiratory and vascular status
 • Anticoagulation therapy
 • Thrombolytic therapy
 • Surgical intervention
 GENERAL MANAGEMENT
 -Oxygen therapy is administered to
correct the hypoxemia, relieve the
pulmonary vascular vasoconstriction, and
reduce the pulmonary hypertension.
 -Using elastic compression stockings
or intermittent pneumatic leg
compression devices reduces venous
stasis.
GENERAL MANAGEMENT

-These measures compress the

superficial veins and increase
the vesecosity of blood in the
deep veins by redirecting the
blood through the deep veins.
 Elevating the leg (above the
level of the heart) also increases
venous flow.
 Anticoagulation
Therapy
 . Anticoagulant therapy (heparin,
warfarin sodium)
 has traditionally been the primary
method for managing acute deep
vein thrombosis and PE
 Anticoagulation
Therapy
 Heparin is used to prevent recurrence of
emboli but has no effect on emboli that
are already present.
 It is administered as an intravenous
bolus of 5,000 to 10,000 units, followed
by a continuous infusion initiated at a
dose of 18 U/kg per hour, not to exceed
1,600 U/hour
 Thrombolytic

Therapy
-Thrombolytic therapy (urokinase,
strepto- kinase, alteplase, anistreplase,
reteplase) also may be used in treating
 PE, particularly in patients who are
severely compromised (eg, those who
are hypotensive and have significant
hypoxemia despite oxygen
supplementation).
 -
 Thrombolytic
Therapy
 Thrombolytic therapy
 resolves the thrombi or emboli
more quickly
 restores more normal hemodynamic
functioning of the pulmonary
circulation, Reducing pulmonary
hypertension
 Improving perfusion, oxygenation,
and cardiac output.
SURGICAL MANAGEMENT

 -Pulmonary embolectomy requires a

thoracotomy with cardiopulmonary
by- pass technique.
 -Transvenous catheter embolectomy is
a technique in which a vacuum-cupped
catheter is introduced transvenously into
the affected pulmonary artery. Suction is
applied to the end of the embolus and
the embolus is aspirated into the cup.
 Nursing Management
 MINIMIZING THE RISK
OF PULMONARY
EMBOLISM
 PREVENTING
THROMBUS FORMATION
 ASSESSING POTENTIAL
FOR PULMONARY
EMBOLISM
 MONITORING
THROMBOLYTIC THERAPY
 Nursing
management
 MANAGING OXYGEN
THERAPY
 RELIEVING ANXIETY
 MONITORING
FOR
COMPLICATIONS
 PROVIDING POSTOPERATIVE
NURSING CARE
 PROMOTING HOME AND
 Mention nursing process of patient
have Pulmonary Embolism ?
 DEFINE the following?
 thrombus
 Embolism
 Pulmonary vascular resistance
-Pulmonary arterial pressure
-The intermittent pneumatic leg
compression
device
-Cardiopulmonary by pass technique
Thank
you