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Updated: Jun 18 2021

Pulmonary Embolism

  • Introduction
    • Introduction
      • procedures associated with pulmonary embolism
        • hip fracture
        • elective total hip arthroplasty
          • the greatest risk of activation of the clotting cascade during total hip arthroplasty occurs during insertion of the femoral component
        • elective total knee arthroplasty
        • spine fracture with paralysis
      • early diagnosis and treatment is most important factor for survival
  • Presentation
    • Saddle emboli can present with death
    • PE should be suspected in postoperative patients with
      • acute onset pleuritic pain and dyspnea
      • tachypnea
      • tachycardia
  • Evaluation
    • EKG; S1Q3T3
      • most common finding sinus tachycardia
    • ABG
  • Imaging
    • CXR (usually normal, may show a prominent hilum)
    • nuclear medicine ventilation-perfusion scan (V/Q)
      • most helpful for dye-sensitive patients
    • pulmonary angiography
      • is gold standard
    • helical chest CT
      • widely considered first line imaging modality
  • Treatment
    • Nonoperative
      • continuous IV heparin infusion followed by warfarin therapy
        • indications
          • in most cases as first line treatment
        • technique
          • continuous IV heparin infusion typically given for 7-10 days
          • warfarin therapy typically given for 3 months
          • monitor heparin therapy with PTT (partial thromboplastin time)
          • monitor coumadin therapy with INR (international normalized ratio)
      • thrombolytics
        • indications
          • in specific cases
        • technique
          • see anticoagulation
  • Complications
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