Updated: 12/22/2019

Pulmonary Embolism

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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 topic
Complications
 
the greatest risk of activation of the clotting cascade during total hip arthroplasty occurs during insertion of the femoral component;
 

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