Pulmonary embolism (PE)

• 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

• 6A: Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary Disorders
• 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning
• 6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated With Airway Clearance Dysfunction
• 6F: Impaired Ventilation and Respiration/Gas Exchange Associated With Respiratory Failure

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 ...