Pulmonary embolism (PE) is part of a group of problems together known as venous thromboembolism (VTE). A PE is a blockage in one of the arteries (blood vessels) in the lungs - usually due to a blood clot. In almost all cases, the cause is a blood clot (thrombus) that has originally formed in a deep vein (known as a DVT). Fatty material from the marrow of a broken bone (if a large, long bone is broken - such as the femur (thigh bone). The symptoms will depend on how large or small the clot is, and on how well the person's lungs can cope with the clot. Chest pain - with a large PE the pain may be felt in the centre of the chest behind the breastbone.
Rarely, in extreme cases, a massive PE can cause cardiac arrest, where the heart stops pumping due to the clot. A type of ultrasound called a duplex Doppler is used to show blood flow in the leg veins, and any blockage to blood flow. The injectable form is heparin (or similar injections called low molecular weight heparins (LMWH)).
If you already know your diagnosis, you may search for the health topic alphabetically here. Disclaimer: This health video may contain graphic material and viewer discretion is advised. Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis, Management, and Prevention of COPD.
Here is yet another awesome case courtesy of Christopher Watford who writes the My Variables Only Have 6 Letters blog.
It’s important to note that the most common ECG abnormality associated with PE is sinus tachycardia. Sinusal tachycardia, with an S1Q3 aspect(???), an increase of the RR, T wave negative from V1 to V4, SpO2=88% —> high suspicion of Pulmonary Embolism !
I read someplace, and I’m trying to remember where, that S1Q3T3 is very non-specific for a PE. TX: as far as the PE goes, not too much you can do pre-hospital aside from continued O2, continued monitoring, IV. Initial assessment was good, I would bump up the O2 to 5LPM (per my protocols 94%spo2 isnt an acceptable stopping point) to see where the SpO2 goes. I would additionally try to inquire about the onset of the dyspnea, if that was with the syncope.
I would start an 18ga or larger IV lock and transport non-emergency to the patient’s usual hospital.
Another hint towards PE that nobody’s mentioned yet (I think) is the somewhat slow R-wave progression in the precordials. I to would be suspicious of a PE, but a little more on the patient’s history would be great. Treatment From The Info Listed: O2, Fluid, but cautiously not to fluid overload, Repeat 12-15 leads, BGL, Etco2, Repeat Vitals. If he has Chronic Bronchitis, then the RAE plus the low voltage QRS may be a sign of Cor Pulmonale as well. It has been my experience that if something is wrong and we are stumped, there is something we didn’t assess?. I disagree Chronic Bronchitis is an episodic disease and is not likely to cause a cor pulmonale or ecg changes suggestive of that. Also of note is the beginnings of a prominent terminal R wave and ST elevation in lead aVR.


No, doubling the paper speed will not reveal hidden P-waves June 22, 2016 RCP de Alto Desempano – ?Rendimiento sobre Protocolo! The human body produces a small amount of pleura liquid in order to lubricate the surfaces of the pleura. Transudative pleural effusions: When there is an increased pressure within the blood vessels or when their protein content is low, it could lead to transudative effusions. If the cause is related to cardiac conditions, the patient may suffer from palpitations or chest pain.
Oxygen supplementation might be administered to the patient if the oxygen level in the blood becomes too low. Complications that can arise due to pulmonary edema are severe oxygen deprivation to different organs of the body such as the brain. If a person develops pulmonary edema, it is vital to take all medication according to the doctor’s instructions. My Father in Law has had to go to the hospital twice in the last 2 weeks because of fluid build up in his lung.
This clot travels through the circulation and eventually gets stuck in one of the blood vessels in the lung.
The CTPA scan is a type of CT scan looking at the lung arteries - the full name is computed tomographic pulmonary angiography scan. Sometimes longer treatment is advised, especially if there is a high risk of a further embolism.
This type of treatment is called catheter embolectomy or catheter fragmentation of the clot. If a PE is treated promptly, the outlook is good, and most people can make a full recovery.
People having major surgery should be assessed for their DVT risk, and people at high risk of DVT may need preventative (prophylactic) doses of heparin or a similar drug before and after surgery. Here, you will learn about how air pollution, occupational dusts and chemicals, and other risk factors can also increase the risk of developing this disease. Adapted from Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis, Management, and Prevention of COPD. There’s S1 Q3 T3, however there is virtually no T wave in II and the T wave in aVF is flipped.
Cardiologically, (is that a word?) be aware of more PVCs and where they fall, and be prepared for another run of ??? The only difference is I would titrate the O2 to keep the SpO2 to my medical director’s likings.
It results in the accumulation of fluids within the layers of the tissues that line the lungs and the chest cavity.
My sister was in the hospital for pleura effusion for a month and the doctors did not know what caused it. Some important risk factors are immobility, other serious illnesses and major surgery (especially gynaecological surgery, and operations on the pelvis and legs).
The outlook is less good if there is an existing serious illness which helped to cause the embolism - for example, advanced cancer. After almost signing out AHA he was persuaded to stay by a doctor and nurse who informed him in no uncertain terms that he would die if he left.
If this were a true S1Q3T3 then the S wave would be deeper than the r wave is tall in lead one (this a right axis) However this is a low sensitivity item (23%). It's not overtly indicated with sats at 96% and no obvious signs of respiratory compromise.
As a consequence of this condition, gas exchange can get affected and eventually lead to respiratory failure.


When an abnormal or excessive collection of this fluid occurs, it leads to pleural effusion. Heart attacks or abnormal heart valves can lead to an abnormal accumulation of blood in the lungs’ blood vessels. If the cause of the pulmonary edema is related to the heart, then appropriate medicines are given to stabilize the heart.
For example, if the cause is related to kidney failure or kidney disease, the doctor will take the necessary steps to address these issues. The risk of developing a DVT or PE in hospital can be greatly reduced by early mobilisation and medicine to help prevent a DVT or PE in those at particular risk. Anticoagulation prevents a PE from getting larger, and prevents any new clots from forming.
The filter is inserted via a thin tube, which is put into a large vein and then fed along the vein into the correct position.
This is a major operation because it involves surgery inside the chest, close to the heart.
The EKG and pt presentation leans toward a PE so it would definitely be high on the list but so would MI. The T wave inversions are quite deep though, suggesting this is new and further suggesting ischemia.
Of course, that can be also due to poor lead placement, but if it was Christopher Watford running the call, I doubt that was the case. New ACLS guidelines oxygen isn't considered as part of the acs treatment unless their saturation is below 92% or they experience aggressive dyspnea. When a clot from peripheral veins, the right atrium or the right ventricle travels into the pulmonary circuit, it effectively blocks forward blood through a portion of the lung bed.
The cause for this condition could be due to the heart’s inability to remove fluids from lung circulation. This in turn can lead to the excessive fluid build up in the alveoli which will affect the gaseous exchange of oxygen and carbon dioxide.
Appropriate medications may be prescribed to strengthen the muscles of the heart, regulate its rhythm or to control its pressure.
Similarly, antibiotics will be given to the patient to deal with infections if the cause of the fluid retention is due to an infection. Regular check ups will also help the doctors identify any possible indication of trouble and give timely treatment. Anticoagulation treatment is usually started immediately (as soon as a PE is suspected) in order to prevent the clot worsening, while waiting for test results. IV, O2, Monitor, ETCO2 would be real good with this guy and then scare him into going to the hospital.
If the embolus is large enough to block a major vessel (or multiple vessels), clinically significant signs and symptoms are likely to occur. With sats increasing with mild oxygenation makes me wonder how a big PE can increase o saturization some easily. Fluid accumulation in the lungs could also be a result of some direct injury to the lung parenchyma. Learning is not memorizing but conceptualizing.Epomedicine also provides quick access to case discussion on interesting medical cases, videos for developing correct clinical skills and a blog to go beyond notes and research articles to explore the inner-self of medical students and healthcare professionals.



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