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Condition/Disorder Synonym

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  • Venous thromboembolism (VTE)

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ICD-9-CM Codes

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  • 415.1 Pulmonary embolism and infarction

  • Associated PT diagnoses/treatment diagnoses that may be associated with respiratory disorders

    • 780.7 Malaise and fatigue

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

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ICD-10-CM Code

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  • I26 Pulmonary embolism

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Preferred Practice Patterns1

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Key Features

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Description

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  • Blockage of the artery of the lung

  • Thrombus (blood clot), commonly from a deep veins in the legs

  • Chest pain with breathing

  • Embolism can be fat or air

  • Increased pressure in the right ventricle of the heart

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Essentials of Diagnosis

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  • Sudden onset shortness of breath (dyspnea)

  • Cyanosis

  • Circulatory dysfunction

  • Pleural effusion

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General Considerations

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  • Can be life-threatening; sudden death can occur

  • Can damage part of the lung

  • Organ damage secondary to reduced oxygen levels

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Demographics

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  • For every 10 years older than 60 years old, the risk of PE doubles1

  • Pregnancy increases risk

  • Obesity increases risk

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Clinical Findings

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Signs and Symptoms

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  • Chest pain

  • Coughing

  • Pulmonary component of the second heart sound

  • Pain worse with deep breath or cough

  • Palpitations

  • Sweating

  • Light-headedness

  • Swelling in one leg

  • Calf pain

  • Cyanosis

  • Increased respiratory rate

  • Fatigue

  • Sudden death

  • Increased heart rate

  • Decreased oxygenation throughout the body

  • Chest tightness

  • Shoulder raised to allow increased lung air flow

  • Shortness of breath

  • Tensed muscles from dyspnea

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Functional Implications

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  • Bleeding problems from blood thinner medication

    • Caution with massage and cross-friction techniques secondary to bruising and bleeding

    • Increased with bleeding and bruising with minimal activities

  • Disabling dyspnea when performing simple tasks (i.e., arm elevation to reach into cabinet)

  • Decreased exercise tolerance

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Possible Contributing Causes

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  • Recent surgery

  • Fractures

  • High blood pressure

  • Air bubble or tumor breaks loose

  • Cancer

  • Female hormone therapy

  • Birth control medication

  • Pregnancy

  • Obesity

  • Long-distance air travel/automobile trip

  • Estrogen

  • Acquired thrombophilia

  • Prolonged bed rest

  • Congenital malformation

  • Venous clot

  • Deep vein thrombosis

  • Virchow's triad

    • Alteration of blood flow

    • Factors in the vessel wall

    • Factors affecting the properties of the blood

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Differential Diagnosis

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  • Congestive heart failure

  • Influenza

  • Asthma

  • Gastroesophageal reflux disease

  • Ludwig's angina

  • Bronchiectasis

  • Cystic fibrosis

  • Kawasaki disease

  • Bronchitis

  • Goiter

  • Upper respiratory tract infection

  • Central airway obstruction

  • Lung tumor

  • Tuberculosis

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • Blood test, clotting status

  • Arterial blood gases

  • Lung function tests

  • Pulse oximetry

  • Wells score

  • Geneva rule

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