Pulmonary Embolism (cont.)
What are the causes and risk factors for pulmonary embolism?
Pulmonary embolus is the end result of a
deep vein thrombosis or
blood clot elsewhere in the body. Most commonly deep vein thrombosis' are seen in the leg, but
can also occur in veins within the abdominal cavity or in the arms.
The risk factors for a pulmonary embolism are the same as the risk factors for deep vein thrombosis. These are referred
to as Virchow's triad and include:
- prolonged immobilization, alterations in normal blood flow (stasis)
- increased clotting potential of the blood (hypercoagulability)
- any damage to the walls of the veins.
Examples of these include the following:
Prolonged immobilization
- Extended travel (sitting in a car, airplane, train, etc.)
- Hospitalization or prolonged bed rest
Increased blood clotting potential
Damage to vessel wall
- Prior deep venous thrombosis
- Trauma to the lower leg with or without surgery or casting
What are the signs and symptoms of pulmonary embolism?
A pulmonary embolus may present with the sudden onset of chest pain and
shortness of breath. The pain is classically sharp and worsens when taking a
deep breath, often called pleuritic pain or pleurisy. There may be
cough that
produces bloody sputum.
The patient may have stable vital signs (blood pressure, heart rate,
respiratory rate, and oxygen saturation) but frequently presents with an
elevated heart rate. A severe pulmonary embolus can present with shock (low
blood pressure) or cardiac arrest,
particularly when a large clot blocks the
outflow of blood from the right side of the heart to the lungs (saddle embolus).
Depending on the amount of blood clot (clot burden or clot load), oxygen
saturation can be variably compromised as can the blood pressure and heart rate.
In a classic presentation, the heart rate and respiratory rate are elevated as
the body tries to compensate.
Oxygen saturation may be decreased (red blood cells
that do not have oxygen molecules attached to them). Oxygen saturation in a
healthy individual approaches 100% at sea level.
The patient may be cyanotic (a blue tinged discoloration of the skin caused
by red blood cells without oxygen), lightheaded, and weak.
In some cases, pulmonary embolus will present with sudden death, where the
patient collapses, stops breathing, and their heart stops beating (cardiac
arrest).
Next: How is pulmonary embolism diagnosed? »
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