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  • Venous thromboembolism (VTE)

  • 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

  • I26 Pulmonary embolism

Description

  • 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

Essentials of Diagnosis

  • Sudden onset shortness of breath (dyspnea)
  • Cyanosis
  • Circulatory dysfunction
  • Pleural effusion

General Considerations

  • Can be life-threatening; sudden death can occur
  • Can damage part of the lung
  • Organ damage secondary to reduced oxygen levels

Demographics

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

Signs and Symptoms

  • 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

Functional Implications

  • 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

Possible Contributing Causes

  • 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

Differential Diagnosis

  • 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

Laboratory Tests

  • Blood test, clotting status
  • Arterial blood gases
  • Lung function tests
  • Pulse oximetry
  • Wells score
  • Geneva rule
  • Percussion of the chest/lungs

Imaging

  • Pulmonary angiography
  • Chest radiograph
  • CT
  • Lung ventilation/perfusion scan
  • Echocardiogram
  • Ultrasound legs for blood clots

  • Normal D-dimer level can exclude thrombotic PE
  • McConnell’s sign on electrocardiogram

Medication

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