Pulmonary embolism is a blockage in the pulmonary arteries of the lungs, usually caused by blood clots traveling from deep leg veins. Left untreated, it can be life-threatening by preventing blood flow to the lungs. Risk factors include recent surgery, cancer, prolonged inactivity, and genetic blood clotting disorders. Symptoms may include shortness of breath, chest pain, and anxiety. Diagnosis involves tests like CT scans, MRI, blood tests, and angiography. Treatment focuses on blood thinners to prevent further clotting and in some cases clot removal procedures. Prevention emphasizes early mobility, compression stockings, and blood thinners especially after surgery or periods of inactivity.

1. PULMONARY
EMBOLISM

2. Introduction
Pulmonary embolism is a blockage in one of the pulmonary arteries in
your lungs. In most cases, pulmonary embolism is caused by blood
clots that travel to the lungs from deep veins in the legs or, rarely, from
veins in other parts of the body (deep vein thrombosis).
Because the clots block blood flow to the lungs, pulmonary embolism
can be life-threatening. However, prompt treatment greatly reduces the
risk of death. Taking measures to prevent blood clots in your legs will
help protect you against pulmonary embolism.

4. Causes
 Blood clots can form for a variety of reasons. Pulmonary embolisms are most often caused
by deep vein thrombosis, a condition in which blood clots form in veins deep in the body. The
blood clots that most often cause pulmonary embolisms begin in the legs or pelvis.
 Blood clots in the deep veins of the body can have several different causes, including:
 Injury or damage: Injuries like bone fractures or muscle tears can cause damage to blood
vessels, leading to clots.
 Inactivity: During long periods of inactivity, gravity causes blood to stagnate in the lowest areas of
your body, which may lead to a blood clot. This could occur if you’re sitting for a lengthy trip or if
you’re lying in bed recovering from an illness.
 Medical conditions: Some health conditions cause blood to clot too easily, which can lead to
pulmonary embolism. Treatments for medical conditions, such as surgery or chemotherapy for
cancer, can also cause blood clots.

5. Types of embolism
1. pulmonary embolism: An embolus, usually formed in the leg (sometimes known as a deep vein
thrombosis or DVT), lodges in one of the arteries of the lungs. Many emboli are broken down by the body
and go away by themselves; however, serious pulmonary embolism may cause death.
2. brain embolism: If a blood clot travels to the brain, this causes an ischemic stroke or TIA (transient ischemic
attack).
3. retinal embolism: Small clots that wouldn't block a major artery can block the smaller blood vessels feeding
the retina at the back of the eye. The result is usually sudden blindness in one eye.
4. septic embolism: This occurs when particles created by infection in the body reach the bloodstream and
block blood vessels.
5. amniotic embolism: Not all emboli are made of clotted blood. In pregnancy, the womb is filled with amniotic
fluid, which protects the fetus. Amniotic fluid can embolize and reach the mother's lungs, causing pulmonary
amniotic embolism.
6. air embolism: Scuba divers who rise to the surface too rapidly can generate air embolism, bubbles in the
blood that can block arterial blood flow.
7. fat embolism: If fat or bone marrow particles are introduced into the blood circulation, they may block blood

6. Risk factors for a pulmonary embolism
Factors that increase your risk of developing deep vein thrombosis and pulmonary
embolism include:
 Cancer
 a family history of embolisms
 Fractures of the leg or hip
 hypercoagulable states or genetic blood clotting disorders, including Factor V Leiden,
prothrombin gene mutation, and elevated levels of homocysteine
 a history of heart attack or stroke
 major surgery
 Obesity
 A sedentary lifestyle
 age over 60 years
 Taking estrogen or testosterone

7. Symptoms
Symptoms of a pulmonary embolism depend on the size of the clot and where it lodges in the lung.
 The most common symptom of a pulmonary embolism is shortness of breath. This may be gradual or sudden.
 Other symptoms of a pulmonary embolism include:
 anxiety
 clammy or bluish skin
 chest pain that may extend into your arm, jaw, neck, and shoulder
 fainting
 irregular heartbeat
 lightheadedness
 rapid breathing
 rapid heartbeat
 restlessness
 spitting up blood
 weak pulse

8. How is a pulmonary embolism diagnosed?
Your doctor will typically perform one or more of the following tests to discover the cause of your symptoms:
 chest X-ray: This standard, noninvasive test allows doctors to see your heart and lungs in detail, as
well as any problems with the bones around your lungs.
 electrocardiography (ECG): This test measures your heart’s electrical activity.
 MRI: This scan uses radio waves and a magnetic field to produce detailed images.
 CT scan: This scan gives your doctor the ability to see cross-sectional images of your lungs. A special
scan called a V/Q scan may be ordered.
 pulmonary angiography: This test involves making a small incision so your doctor can guide
specialized tools through your veins. Your doctor will inject a special dye so that the blood vessels of
the lung can be seen.
 duplex venous ultrasound: This test uses radio waves to visualize the flow of blood and to check for
blood clots in your legs.
 venography: This is a specialized X-ray of the veins of your legs.
 D-dimer test: A type of blood test.

9. Treatment
The treatment for a pulmonary embolism depends on the size and location of the blood clot. If
the problem is minor and caught early, your doctor may recommend medication as treatment.
Some drugs can break up small clots.
Drugs your doctor may prescribe include:
anticoagulants: Also called blood thinners, the drugs heparin and
warfarin prevent new clots from forming in your blood. They can save
your life in an emergency situation.
clot dissolvers (thrombolytics): These drugs speed up the breakdown
of a clot. They’re typically reserved for emergency situations because
side effects may include dangerous bleeding problems.

10. Surgical treatment
Surgery may be necessary to remove problematic clots, especially those that restrict blood flow to the lungs
or heart. Some surgical procedures your doctor may use in the case of a pulmonary embolism include:
vein filter: Your doctor will make a small incision, then use a thin wire to
install a small filter in your inferior vena cava. The vena cava is the main
vein that leads from your legs to the right side of your heart. The filter
prevents blood clots from traveling from your legs to your lungs.
clot removal: A thin tube called a catheter will suction large clots out of
your artery. It isn’t an entirely effective method because of the difficulty
involved, so it’s not always a preferred method of treatment.
open surgery: Doctors use open surgery only in emergency situations
when a person is in shock or medications aren’t working to break up the
clot.

11. Surgical treatment
vein filter
Open heart surgery
Clot removal

12. Nursing Interventions
Nursing care for a patient with pulmonary embolism includes:
◦ Prevent venous stasis: Encourage ambulation and active and passive leg
exercises to prevent venous stasis.
◦ Monitor thrombolytic therapy: Monitoring thrombolytic and anticoagulant
therapy through INR or PTT.
◦ Manage pain: Turn patient frequently and reposition to improve ventilation-
perfusion ratio.
◦ Manage oxygen therapy: Assess for signs of hypoxemia and monitor the
pulse oximetry values.
◦ Relieve anxiety: Encourage the patient to talk about any fears or concerns
related to this frightening episode.

13. Prevention
Preventing clots in the deep veins in your legs (deep vein thrombosis) will help prevent pulmonary embolism. For
this reason, most hospitals are aggressive about taking measures to prevent blood clots, including:
 Blood thinners (anticoagulants). These medications are often given to people at risk of clots before and after an
operation — as well as to people admitted to the hospital with medical conditions, such as heart attack, stroke or
complications of cancer.
 Compression stockings. Compression stockings steadily squeeze your legs, helping your veins and leg muscles
move blood more efficiently. They offer a safe, simple and inexpensive way to keep blood from stagnating during
and after general surgery.
 Leg elevation. Elevating your legs when possible and during the night also can be very effective. Raise the bottom
of your bed 4 to 6 inches (10 to 15 cm) with blocks or books.
 Physical activity. Moving as soon as possible after surgery can help prevent pulmonary embolism and hasten
recovery overall. This is one of the main reasons your nurse may push you to get up, even on your day of surgery, and
walk despite pain at the site of your surgical incision.
 Pneumatic compression. This treatment uses thigh-high or calf-high cuffs that automatically inflate with air and
deflate every few minutes to massage and squeeze the veins in your legs and improve blood flow.

14. The end
By – Nitin sharma