PULMONARY EMBOLUS
Pulmonary embolus (PE) is a potentially fatal result of DVT in which emboli
travel through the venous system to the lungs. The source of the emboli is most
commonly in the lower extremities or pelvis.
Clinical Findings: Symptoms include chest pain and dyspnea (80%) but no
single symptom(s) predominate because thrombi location varies. Physical and
imaging findings include:
Tachypnea (90%)
Chest x-ray often normal
ABG showing low pO 2 (but often in the normal range)
EKG that may show tachycardia
Right axis deviation (but usually is normal)
Diagnosis depends on the pulmonary imaging modalities used. Spiral CT
scan of the chest is the best initial test for suspected PE. Pulmonary
angiography is the most definitive diagnostic method; most common
indication is a negative spiral CT scan in a high-risk and symptomatic patient.
Management: Full anticoagulation (IV, SQ) heparin to increase PTT by 1.5–
2.5 times the control value. No warfarin is used antepartum due to teratogenic
concerns. Perform thrombophilia workup.