Pulmonary Embolism PDF

Pulmonary Embolism Dr. Ahmed Hamad MBBS, PgDip (Therapeutics), MRCP (Respiratory Medicine), FRCP (London), FACP Consultant Pulmonologist PMAH, Riyadh Objectives Prevalence Risk Factors Clinical Features Pathophysiology Diagnosti...

Pulmonary Embolism Dr. Ahmed Hamad MBBS, PgDip (Therapeutics), MRCP (Respiratory Medicine), FRCP (London), FACP Consultant Pulmonologist PMAH, Riyadh Objectives Prevalence Risk Factors Clinical Features Pathophysiology Diagnostic Workup Treatment Prevalence 50,000 individuals die from PE each year in USA The incidence of PE in USA is 500,000 per year Risk Factors General anesthesia Lower limb or pelvic injury/surgery Congestive heart failure Prolonged immobility Pregnancy and postpartum Oral contraceptives Malignancy Thrombophilia Prior DVT/ PE Clinical Features Symptoms Signs Sudden onset dyspnea Tachypnea Pleuritic Chest pain Tachycardia Syncope Cyanosis Hemoptysis Hypotension Palpitations Fever Lower limb swelling/ pain DVT signs Swelling Tenderness redness Pathophysiology Thromboembolism Fat Broken long bones Lower limb DVT Abdominal embolism Pelvic veins EEE Abdominal veins Tumor Upper limb DVT Air Iatrogenic embolism Suicidal Amniotic fluid Pathophysiology Massive PE Increase in Pulmonary Vascular Resistance Right ventricular outflow obstruction Increase in RV pressure Right ventricular RV failure Decrease left ventricular preload Decrease cardiac output CO Diagnosis Bedside Imaging ECG CXR Blood pressure CT Pulmonary angiogram b V/Q scan Blood tests Echo CBC US Doppler Coagulation profile Renal and liver profile D-Dimer Cardiac enzymes Troponin ABG Thrombophilia screen Treatment Medical Surgical / interventional radiology General supportive management Vein filter Blood thinners (Anticoagulation) Catheter-directed Heparin IV/SC Thrombectomy Warfarin DOAC Embolectomy Clot dissolver (Thrombolytics) Higher risk of bleeding