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EMBOLUS
• Thrombotic
• Non-thrombotic : Fat, Air, Tumour , Amniotic fluid, IV Drug abusers.
RISK FACTORS
Signs
Tachypnea (≥ 20/min)
Tachycardia (> 100/min)
Signs of DVT
Fever (> 38.5 ºC)
Cyanosis
Investigation
• ECG :
Signs of RV strain, such as inversion of T waves in leads V1-
V4, a QR pattern I lead V1
The classic S1Q3T3 type
Right bundle-branch block
In a patient with shock or hypotension, the absence of ECG
signs of RV overload or dysfunction excludes PE as a cause of
hemodynamic compromise.
• Echocardiography
• ABG :
Hypoxemia, Hypocapnia, Non-specific
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Small pleural effusion
Elevated diaphragm
Pleural based opacities with convex medial margins are also
known as a Hampton's Hump
Westermark sign : Dilatation of pulmonary vessels proximal
to embolism along with collapse of distal vessels, often with a
sharp cut off.
• Isoenzyme Pattern(Troponin T,I)
To distinguish PE from MI
• Leucocytic Count:
< 15 000, If over 15 000, consider Bacterial Sepsis
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The combination of a high-probability ventilation-perfusion
scan plus a high clinical suspicion is diagnostic for pulmonary
embolism.
A low-probability or normal lung scan with a low clinical
suspicion makes the diagnosis of pulmonary embolism unlikely
• Computed tomography
• Pulmonary angiography
• MRI / MR Angiogram
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Diagnostic strategies
Hence, the most useful initial test is ECG, which will usually show indirect
signs of acute pulmonary hypertension and right ventricular overload if
acute PE is the cause of hemodynamic consequences.
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Treatment
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☼ Thrombolysis
Initial anticoagulation:
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Anticoagulation with parenteral anticoagulants should be continued
for at least 5 days and vitamin K antagonists (VKA) should be
initiated as soon as possible and preferably on the same day as the
initial anticoagulant.
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☼ Long term anticoagulation and secondary prophylaxis:
☼ Venous filters:
Specific problems
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Pregnancy
The radiation dose of chest CT delivered to the fetus is lower than that
of the perfusion lung scintigraphy in the first or second trimesters and
that it can be performed safely.
Streptokinase does not cross the placenta and at the time of delivery,
thrombolytic treatment should not be used except in extremely severe
cases and if surgical embolectomy is not available.
Malignancy
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Malignancy is a major predisposing factor for the development and
recurrence of VTE.
In cancer patients with confirmed PE, LMWH should be considered
for the first 3-6 months of treatment and anticoagulant treatment
should be continued indefinitely.
They include broken catheters, guidewires and vena cava filters and more
recently coils for embolization
Intravascular retrieval using snares is frequently successful.
Fat embolism
Dyspnea, cyanosis and shock that are abrupt in onset classically progress to
cardiopulmonary collapse.
The diagnosis is one of exclusion and treatment is supportive.
Talc embolism
Tumor embolism
NB:
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PE , Clinical Features
C/P
• Pleuritic chest pain, Pleural rub, Pleural effusion
• Hemoptysis: in only 50% of cases
• Tachcardia( more than 100/ min ) Tachypnoea
• Jaundice, Cyanosis
• Locally: No Physical Findings, Consolidation, Diminished Intensity
of Breath Sounds, Crepitus, Wheezing Chest
• Pleural Rub
• Signs of Pleural Effusion
• With Infection: Worsening of the Clinical Status: Abscess or
Empyema
• Persistent Fever, Malaise, Sweating
• Increasing Pulse Rate
• Leucocytosis more than 20 000
• Chest X-Ray
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