Weekly question from archived Gold Cross CEU Articles.
CEU Test #95 "Lung Diseases". by Sylvie Mulvaney and Louis A. Sforza.
Which of the following is a known cause or contributing factor to pulmonary embolism?
a. Virchow's Triad
b. history of cigarette smoking
c. left ventricle
d. all of the above
Pulmonary embolism (PE) occurs when a blood clot lodges in an artery in the lung, blocking blood flow to part of the lung.
Pathophysiology – The more vessels blocked, the more severe the condition, obviously. Blood clots often originate in the legs and travel up in the inferior vena cava, through the heart’s right atrium and right ventricle before reaching the pulmonary arteries. (see figure 5)
In cases of atrial fibrillation, clots can originate in the right atrium of the heart. Due to its wide range of differential diagnoses, PE often is difficult to identify in young people who typically are in good health and have good pulmonary reserve. For people with comorbid factors such as CHF, COPD or hypertension, even a small clot can cause symptoms. A thorough patient history – and a high index of suspicion – can help the EMT narrow the list of probable causes of the patient’s symptoms.
Causes – Three predisposing factors are:
local trauma to a vessel wall; stasis of the blood; and hypercoagulability. This is known as Virchow’s Triad. The EMT should look for a history of cigarette smoking, a prior blood clot, sedentary lifestyle, long-bone fractures, pregnancy, recent hip or leg surgery, contraceptive use or stasis of position, as would be the case with a long car trip or air travel.
Assessment – PE patients can present with acute onset of dyspnea without explanation, diaphoresis, cough, anxiety, tachycardia and tachypnea, complaints of pleuritic chest pain or lower back pain, a change in mental status due to hypoxia, cyanosis, even sudden death. Good auscultation of lung sounds is a must. Interventions – Ensure adequate oxygenation with either supplemental oxygen via nasal cannula, nonrebreather mask or a bag-valve mask and transport the patient promptly to the nearest emergency room.
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