Pulmonary Embolism

Symptoms
  • Tachycardia
  • Elevated RR
  • Hemoptysis
  • Pulmonary HTN
Labs
  • ABG
    • Elevated pH
    • Decreased Pc02
    • Decreased p02
  • D-Dimer
    • + Test does not rule in PE
    • – Test rules out PE
Treatment
  • Anticoagulation
    • IV Heparin
    • Enoxaparin/Lovenox
    • Warfarin/Coumadin
  • SCD’s
  • Heparin 5,000 Units SQ BID/TID
  • Lovenox 40mg SQ, QD
  • Lovenox 30mg SQ, QD for patients with renal failure
Risk Factors
  • Orthopedic Procedures
  • No prophylaxis
  • Abdominal / Pelvic Surgeries
  • Obesity
  • Women >30, + Oral Contraceptives + Smoker
  • Hypercoagulable state
    • Protein C + S Deficiencies
    • Factor V Leiden
  • Pregnancy
Imaging
  • Ultrasound
    • + clot & respiratory symptoms rules in PE
    • – clot does not rule out PE
  • Chest X-Ray
    • Normal X-Ray is the most typical finding
    • Hampton’s Hump (not definitive)
    • Westermarks Sign (not definitive)
  • V/Q Scan
  • CT-Angio
  • EKG
    • Peaked T waved in V1,V2,V3
    • S1,Q3,T3