Pulmonary Symbolism Essay

Overview of Pulmonary Embolism
An embolism is a foreign mass that travels through the intravascular space carried by the systemic circulation. The mass may be solid, liquid or gaseous. The circulation carries the embolus through vessels to parts of the body where it can cause obstruction or occlusion. The Pulmonary Embolism (PE) occurs when the embolism causes an obstruction or occlusion of the pulmonary artery or one of its branches, which in turn reverts pressure on the right ventricle.
A solid embolus can be a thrombus, also known as a blood clot, which traveled through the circulation to cause obstruction or occlusion in a location distant from its origin. A thrombus is always a solid, non-traveling stationary body that causes obstruction
There should be a high index of suspicion for PE when a patient presents with signs and symptoms of acute coronary syndrome and a history that is suggestive for PE. The patient experiencing PE will generally present with difficulty breathing, chest pain on inspiration, and palpitations. Patient assessment will typically show signs of decreased oxygen saturation (SpO2), cyanosis, rapid breathing, and a rapid heart rate. Severe cases of PE may include syncope, low blood pressure, and sudden death (Goldhaber, Pulmonary Thromboembolism). In the instance of a significant occlusion of the pulmonary artery the immediate result is sudden dilatation of the right ventricle and right auricle, also known as acute cor pulmonale. (Mcginn and White) When presentation is suggestive for PE, evaluation risk factors and additional clinical signs can increase the index of suspicion. Risk factors for PE include: surgery within the past three (3) months, recent period of immobilization, previous venous thromboembolism (VTE), family history of VTE, current cancer treatment, smoking and the use of oral contraception. Additional clinical signs of PE include: dyspnea, pleuritic chest pain, non-retrosternal chest pain, hemoptysis, pleural rub, heart rate > 90 beats/min, leg symptoms such as DVT, low-grade fever, chest radiograph compatible with PE, syncope, and electrocardiographic (ECG) signs of
(Wiener, Ouellette and Diamond) D-dimer greater than five-hundred nanograms per milliliter (> 500 ng/mL) or 10 times the patient’s age in years over 50 (Age X 10) is suggestive for thromboembolism and justifies further testing. False positive D-dimer results can be seen in patients with liver disease, high rheumatoid factor, inflammation, malignancy, trauma, pregnancy, recent surgery or advanced age. False negative results can be seen in patients when the sample is taken too soon after thrombus formation, when testing is not done for several days after initial presentation or when patients are on anti-coagulation therapy (Es, Mos and