17- pulmonary embolism

• Pulmonary embolism

  Occlusion of the pulmonary vasculature by a blood clot
• Pulmonary embolism

  • Medical emergency; can lead to sudden death if not managed in time
  • Pulmonary emboli most commonly arise from thrombi in the deep veins of the leg (DVT)
  • Other sources: pelvic and upper extremity veins, or the right chamber of the heart
• Pathophysiology of pulmonary embolism

  1. Increased venous stasis: immobility, obesity, and congestive heart failure

  2. Endothelial injury due to trauma, surgery, recent fracture, previous DVT

  3. Hypercoagulability: pregnancy and oral contraceptive use, cigarette smoking, coagulation disorders
• Management of pulmonary embolism

  1. Hemodynamically stable patients: anticoagulation therapy as soon as possible, continued for 3-6 months. Patients with high risk of recurrence may need life-long anticoagulation. If contraindications to anticoagulation or high risk of bleedingàinferior vena cava filter is placed.

  2. Hemodynamically unstable patients: need thrombolytic therapy if there are no contraindications. If thrombolysis is contraindicated or unsuccessful: surgical or catheter-based embolectomy is performed