Pulmonary Embolism (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
George Schiffman, MD, FCCP
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Pulmonary embolism facts
- What is a pulmonary embolism?
- What are the causes and risk factors for pulmonary embolism?
- What are the signs and symptoms of pulmonary embolism?
- How is pulmonary embolism diagnosed?
- History and physical examination
- Basic testing (CBC, electrolytes, BUN, creatinine blood test, chest x-ray, EKG)
- Pulmonary angiogram
- d-Dimer blood test
- CT Scan
- Ventilation-perfusion scans
- Venous Doppler study
- Echocardiography (EKG, ECG)
- What is the treatment for pulmonary embolism?
- Anticoagulation
- Thrombolytic therapy
- What is the prognosis for pulmonary embolism?
- Can pulmonary embolism be prevented?
Thrombolytic therapy
Pulmonary embolism can be fatal, especially if involves a large amount of clot. When the patient is unconscious, has low or no blood pressure or are not breathing, clot busting or thrombolytic therapy using medications like TPA (tissue plasminogen activator) may be considered. It is also often considered when signs of right heart strain are present.
In certain centers, a special procedure can be performed where is catherter is placed in the right side of the heart and the clot is essentially vacuumed out.
What is the prognosis for pulmonary embolism?
Patient survival depends upon:
- the underlying health of the patient,
- size of the pulmonary embolus,
- the cause of the pulmonary embolus, and
- the ability for a diagnosis to be made and treatment initiated.
The diagnosis is often difficult, and it is estimated to that there are up to 400,000 cases of pulmonary embolus that are not diagnosed in the United States each year.
In those patients where the diagnosis is made, the mortality rate is less than 20% when considering all patients. Usually, however, the mortality risk is much less in most patients. The higher incidence of death occurs in patients that are older, have other underlying illnesses, or have a delay in diagnosis. Racial differences may also exist, but probably are due more to access to quality care than a specific genetic difference.
How can pulmonary embolism be prevented?
Minimizing the risk of deep vein thrombosis minimizes the risk of pulmonary embolism. The embolism cannot occur without the initial DVT.
- In the hospital setting, the staff works hard to minimize the potential for clot formation in immobilized patients. Compression stockings are routinely used. Surgery patients are out of bed walking (ambulatory) earlier and low dose heparin or enoxaparin is being used for deep vein thrombosis prophylaxis (measures taken to prevent deep vein thrombosis).
- For those who travel, it is recommended that they get up and walk every couple of hours during a long trip.
- Compression stockings may be helpful in preventing future deep vein thrombus formation in patients with a previous history of a clot.
REFERENCES:
Carman, tl, Gegaj F Management of Pulmonary Embolism: 2010 State of the Art Update
Curr Treat Options. Cardiovasc Med. 2010 Apr;12(2);168-184
Tintinalli J, etal. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th edition. McGraw-Hill Professional 2010.
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