Sunday, January 15, 2006

pulmonary embolus

Pulmonary embolism is the lodgement of a foreign substance such as a clot or particle of fat in a pulmonary arterial vessel. The source of the embolism may be a thrombi (clot) originating in the iliac, femoral, or pelvic veins. They are common in older people who are confined to bed. Predisposing conditions to pulmonary embolism are recent surgery, fracture, or trauma of the lower extremities, and a debilitating disease.
Pulmonary emboli almost always occur suddenly. The size of the pulmonary artery and number of emboli determine the severity of the symptoms. If the embolus blocks the pulmonary artery or one of its main branches, immediate death may occur. Symptoms of a pulmonary embolism include severe chest pain, dyspnea, cyanosis, tachycardia, and shock. When a smaller area of the lung is involved, symptoms are less severe and may include pain, tachycardia, and dyspnea. Fever, cough, and blood streaked sputum may also be present.
The diagnosis is made by the clinical history, chest film, lung scans, and pulmonary angiography. In addition, EKGs and serum enzymes may assist in the diagnosis. Treatment of a pulmonary embolus will depend on the size of the area involved. Intravenous heparin is started to prevent extension of the thrombus and to prevent the formation of additional thrombi. Placing the patient in high Fowler's position usually helps his or her breathing. This position is elevation of the head of the bed and placement of the patient in a semi sitting position.
A pulmonary embolectomy (cut made in an artery to remove a blood clot) using a cardiopulmonary bypass may be necessary if the clot is lodged in a main pulmonary artery.
Prevention includes exercises to strengthen leg muscles and prevent venous thrombus formation and early ambulation after surgery.
Scherer, J. C. Introductory Medical-Surgical Nursing. Philadelphia: J. B. Lippincott Co., 1982.

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