Plumunary Embolism (PE).pptx OBSTRACTION ON PA

Plumunary Embolism

1. PULMONARY EMBOLISM PRESENTED BY, MUTEGEKI ADOLF KSHS

2. INTRODUCTION Problems of the vascular system includes disorders of the arteries and veins. Peripheral arterial disease is a term used to describe a wide variety of conditions affecting arteries in the neck, abdomen and extremities. Peripheral arterial disease can be subdivided into occlusive disease, aneurismal disease, and vasopastic phenomenon. In contrast,venous diseases primarily affect the lower extremities and can be categorised into venous thrombosis and chronic venous insufficiency.

3. DEFINITION Pulmonary embolism (PE) is a serious and potentially life-threatening condition characterized by the obstruction of the pulmonary arteries by a blood clot . The clot usually originates in the deep veins of the legs (deep vein thrombosis, DVT) and travels to the lungs . PE can impair gas exchange and lead to significant hemodynamic compromise.

4. INCIDENCE Actual incidence of mortality and morbidity from pulmonary embolism is unknown, it is estimated that nearly 50,000 people die of pulmonary disease each year in the United states and another 650,000 have non fatal pulmonary embolism.

5. ETIOLOGY AND RISK FACTORS Deep Vein Thrombosis ( DVT) Hypercoagulable States : Conditions that increase blood clotting, such as cancer, genetic clotting disorders (e.g., Factor V Leiden), pregnancy, or hormone replacement therapy. Prolonged Immobilization : Bed rest, long-haul flights, or surgery, especially orthopedic surgery of the lower extremities.

6. Surgery and Trauma : Especially orthopedic and pelvic surgeries. Malignancy : Certain cancers increase the risk of thrombosis. Obesity : Increases the risk of developing DVT and subsequently PE. Smoking : Contributes to endothelial damage and hypercoagulability. Previous History of DVT/PE : Patients with a history of DVT or PE are at increased risk of recurrence

7. CLINICAL FEATURES S everity of clinical manifestations of pulmonary embolism depends on the size of the emboli and the size and number of blood vessels occluded.Most common manifestations are , Anxiety Sudden onset of unexplained dyspnea Tachypnea or tachycardia Cough Pleuritic chest pain Hemoptysis Crackles

8. Fever Accentuation of the pulmonic heart sound Sudden change in mental status as a result of hypoxemia In massive emboli , Shock Pallor Severe dyspnea Crushing chest pain Pulse is rapid and weak Bp is low ECG indicates right ventricular strain

9. In medium sized emboli, Pleuritic chest pain Dyspnea Slight fever Productive cough with blood streaked sputum In small emboli, Pulmonary hypertension ECG and chest X-ray indicates right ventricular hypertrophy

10. PATHOPHYSIOLOGY Embolism Formation : A clot, typically formed in the deep veins of the legs, dislodges and travels through the venous system. Lodging in Pulmonary Arteries : The embolus travels to the right side of the heart and is pumped into the pulmonary arteries, where it becomes lodged.

11. Impaired Gas Exchange : The obstruction prevents blood from reaching parts of the lung, resulting in areas that are ventilated but not perfused (dead space). This leads to hypoxemia .

12. Increased Pulmonary Vascular Resistance : Obstruction of pulmonary arteries increases resistance, leading to strain on the right ventricle, which can result in right ventricular failure. V/Q Mismatch : The mismatch between ventilation and perfusion leads to inefficient gas exchange.

13. DIAGNOSTIC STUDIES History and physical examination Venous studies Chest X-ray Continous ECG monitoring ABGs CBC count with WBC differential D –dimer level (Biomarker for thrombotic disorders) Lung scan(ventilation and perfusion) Pulmonary angiography CT scan

14. MEDICAL MANAGEMENT The objectives of treatment are , Prevent further growth or multiplication of thrombi in the lower extremities Prevent embolization from the upper or lower extremities to the pulmonary vascular system. Provide cardiopulmonary support if indicated.

15. CONSERVATIVE THERAPY The administration of O2 by mask or cannula may be adequate for some patients.O2 is given in a concentration determined by ABG analysis . In some situations,endotracheal intubation and mechanical ventilation may be needed to maintain adequate oxygenation . Respiratory measures such as turning , coughing and deep breathing are necessary to prevent or treat atelectasis .

16. If shock is present, vasopressor agents may be necessary to support systemic circulation . If heart failure is present, digitalis and diuretics are used. Pain resulting from pleural irritation or reduced coronary blood flow is treated with narcotics, usually morphine

17. DRUG THERAPY Anticoagulant therapy-Properly managed anticoagulant therapy is effective in the treatment of many patients with pulmonary embolism . Heparin and Warfarin are the anticoagulant drugs of choice . Unless contraindicated , heparin should be started immediately and is continued while oral anticoagulants are initiated . The dosage of heparin is adjusted according to PTT and warfarin dose is determined by International normalized ratio.

18. Fibrinolytic therapy-The effectiveness of fibrinolytic therapy in the management of a massive pulmonary embolism is not clear,but it may be useful in clients who are hemodynamically unstable. Thrombolytic agents lyse the clots and restore right-sided heart function.

19. Fibrinolytic therapy-The effectiveness of fibrinolytic therapy in the management of a massive pulmonary embolism is not clear,but it may be useful in clients who are hemodynamically unstable. Thrombolytic agents lyse the clots and restore right-sided heart function.

20. SURGICAL MANAGEMENT Surgical interventions that may be used in the treatment of pulmonary embolism include, Vena caval interruption with the insertion of a filter and Pulmonary embolectomy The Greenfield filter , a basket like cone of wires bent to look like an umbrella ,is the most commonly used filter.

21. The filter allows blood flow while trapping emboli, however venacava filters are less effective than coagulation and may lead to deep vein thrombosis and so these are generally are used only when anticoagulants are contraindicated or ineffective.

22. PREVENTION Prophylactic Anticoagulation : In high-risk patients (e.g., post-surgical, immobile patients). Compression Stockings Compression Devices : To prevent DVT in hospitalized or post-operative patients. Early Mobilization : Encouraging movement after surgery to reduce the risk of clot formation. Lifestyle Modifications : Smoking cessation, weight management, and regular exercise