What is a Pulmonary embolism (PE)?
Here we will discuss pulmonary embolism treatment and management for nurses and nursing students to help with the understand of this disease process. A PE occurs when one or more pulmonary arteries in the patients lungs have become blocked. It is possible that the pulmonary embolism was a result of a blood clot or clots that migrated to the lungs from the legs or even another part of the body, these clots from another part of the body are called DVT (deep vein thrombosis).
Since a pulmonary embolism usually always happens with a deep vein thrombosis, the two conditions together are referred to as venous thromboembolism.
While cancer, immobility, and surgery increase the risk of developing a pulmonary embolism, anyone can develop a PE.
Sign and Symptoms:
Depending on how much of the lung is involved, the signs and symptoms can vary greatly, especially if the patient has an underlying heart or lung disease.
Some of the hallmark signs and symptoms include:
- Cough – the patient may have bloody or blood streaked sputum.
- Shortness of breath – appears suddenly and worsens with exertion.
- Chest pain – gets worse with exertion and does not go away even if resting. May have pleurisy (pain with deep breathing).
- Leg pain – usually in the calf. The affected calf may also have some swelling.
Other signs and symptoms:
- Rapid and or irregular heartbeat
Usually a blood clot will break off and land in to an artery in the lungs. The most common site of origin is in the deep veins of the legs. However, these blood clots can some from other parts of the body known as DVT’s or deep vein thrombosis. It is important to point out that blockages can form from other substances in your body that travel and block the arteries in the lungs.
- Air bubbles
- Fat from broken long bone marrow
- Pieces of tumor
A patient will not usually have a single pulmonary embolism, usually there are multiple clots. The lung tissue that has a blocked artery will not get the needed blood supply and may die. If this happens there is less oxygen supply to the rest of the body.
- Long Travel: Sitting in the same position for a long plane or car ride slows down blood flow, which helps to form clots in your legs.
- Prolonged bed rest: being confined to a bed due to illness causes the flow of venous blood to slow and the blood will pool in the lower extremities.
- Cancer: Pancreatic, lung, ovarian and any other cancers with metastasis as they can increase the level of materials that can help form clot formations. Tamoxifen and Raloxifene are medications taken for a diagnosis of breast cancer, but these medications also increase the risk of blood clots as does chemotherapy.
- Heart disease: Clots can form with a history of cardiovascular disease and hypertension.
- Surgery is one of the largest causes for the formation of blood clots. The risk increases depending on how long the patient is immobile in the operating room. Some patients will be given medications before and after surgery to prevent clot formation.
- Pregnancy: a fetus pressing on veins in pelvis can slow return of blood flow from the legs.
- Smoking: can predispose a patient to blood clot formation.
- Overweight: Obesity increases risk of blood clot formation.
- Estrogen: Clotting factors in the blood may be increased with hormone replacement therapy and the use of birth control pills.
- CT Scan
- Blood test called D-dimer
- Chest X-ray to rule out other illness that may mimic symptoms of a pulmonary embolism.
- Ultrasound to check for clots in the legs.
- V/Q lung scan shows ventilation and perfusion in the lungs.
- MRI usually done for patients who should not have contrast dye examples would be a pregnant or renal patient.
- Pulmonary angiogram shows a clear image of blood flow of arteries in the lungs. This is the most accurate way to diagnose however, it is very invasive.
Pulmonary Embolism treatment
- Anticoagulants: These blood thinners prevent new clot formation.
- Thrombolytics: This medication is used to dissolve clots. Watch for bleeding
- Vein filter: An IVC (inferior vena cava) filter is placed in the inferior vena cava. Blood clots are blocked from going into the lungs.
- Surgery: Large clots may need to be removed via surgical procedures.
A pulmonary embolism can cause pulmonary hypertension. In pulmonary hypertension, the blood pressure in the lungs and right side of the patients heart is too high, so the heart must work harder to to get blood through those vessels. Approximately 1/3 of patients with untreated and undiagnosed pulmonary embolisms may not survive as this condition is life threatening. If the patient receives prompt medical treatment, their chances of survival increases dramatically.
The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education and should not be used as a substitute for professional diagnosis and treatment.