Pulmonary embolism (PE) occurs when a blood clot gets lodged in an artery in the lung, blocking blood flow to part of the lung. Blood clots most often start in the legs and travel up through the right side of the heart and into the lungs. This is called DVT. However, PE sometimes can occur without any evidence of DVT.

1. Pulmonary embolism (PE)
Prepared by
Mr.Abhay Rajpoot
HOD (Dep. of Medical Surgical)
abhayrajpoot5591@gmail.com

2. INTRODUCTION
Pulmonary embolism (PE) occurs when a
blood clot gets lodged in an artery in the
lung, blocking blood flow to part of the
lung.
Blood clots most often start in the legs
and travel up through the right side of the
heart and into the lungs. This is called
DVT.
However, PE sometimes can occur
without any evidence of DVT.

3. DEFINITION
Pulmonary embolism is a blockage in one of the pulmonary arteries in
the 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)

5. INCIDENCE
While no exact epidemiological data are available,
the incidence of PE is estimated to be approximately 60 to 70
per 100,000, and that of venous thrombosis approximately 124
per 100,000 of the general population

6. RISK FACTOR
 Heart disease. Cardiovascular disease, specifically heart failure, makes clot
formation more likely.
 Cancer. Certain cancers — especially brain, ovary, pancreas, colon, stomach, lung
and kidney cancers, and cancers that have spread —can increase the risk of blood
clots, and chemotherapy further increases the risk.
 Surgery. Surgery is one of the leading causes of problem blood clots. For this reason,
medication to prevent clots may be given before and after major surgery, such as joint
replacement.
 Disorders that affect clotting. Some inherited disorders affect blood, making it more
prone to clot. Other medical disorders such as kidney disease can also increase your
risk of blood clots.
 Coronavirus disease 2019 (COVID-19). People who have severe symptoms
of COVID-19 have an increased risk of pulmonary embolism

8. ETIOLOGY
Pulmonary embolism occurs when a clump of material, most often a
blood clot, gets wedged into an artery in your lungs. These blood clots
most commonly come from the deep veins of your legs, a condition
known as deep vein thrombosis (DVT).
• Fat from the marrow of a broken long bone
• Part of a tumor
• Air bubbles

9. CLINICAL MENIFESTATION
• Shortness of breath. This symptom typically appears suddenly and
always gets worse with exertion.
• Chest pain. You may feel like you're having a heart attack. The pain is
often sharp and felt when you breathe in deeply, often stopping you
from being able to take a deep breath. It can also be felt when you
cough, bend or stoop.
• Cough. The cough may produce bloody or blood-streaked sputum.

10. Other signs and symptoms that can occur with pulmonary embolism
include:
• Rapid or irregular heartbeat
• Lightheadedness or dizziness
• Excessive sweating
• Fever
• Leg pain or swelling, or both, usually in the calf caused by a deep
vein thrombosis
• Clammy or discolored skin (cyanosis

11. DIAGNOSTIC EVALUATION
Chest X-ray:
Electrocardiography (ECG): This test measures the heart’s electrical activity.
MRI: This scan uses radio waves and a magnetic field to produce detailed
images.
CT scan: This scan gives ability to see cross-sectional images of the lungs.
Pulmonary angiography: This test involves making a small incision so the
doctor can guide specialized tools through the veins. The 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 the legs.
• D-dimer test: A type of blood test.

12. MEDICAL MANAGEMENT
Medications
Medications include different types of blood thinners and clot dissolvers.
• Blood thinners (anticoagulants). These drugs prevent existing clots from enlarging and
new clots from forming while the body works to break up the clots. Heparin is a
frequently used anticoagulant that can be given through the vein or injected under the
skin. It acts quickly and is often overlapped for several days with an oral anticoagulant,
such as warfarin, until it becomes effective, which can take days.
• Clot dissolvers (thrombolytics). While clots usually dissolve on their own, sometimes
thrombolytics given through the vein can dissolve clots quickly. Because these clot-
busting drugs can cause sudden and severe bleeding, they usually are reserved for life-
threatening situations.

13. SURGICAL MANAGEMENT
• Clot removal. If you have a very large, life-threatening clot in the
lung, the doctor may suggest removing it via a thin, flexible tube
(catheter) threaded through your blood vessels.
• Vein filter. A catheter can also be used to position a filter in the body's
main vein (inferior vena cava) that leads from your legs to the right
side of the heart. This filter can help keep clots from going to the lungs.
This procedure is typically reserved for people who can't take
anticoagulant drugs or when they have had recurrent clots despite use
of anticoagulants. Some filters can be removed when no longer needed.

14. PREVENTION
 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 the legs, helping to
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.

15. NURSING DIAGNOSIS
 Ineffective airway clearance related to excessive mucous congestion as
evidenced by shortness of breath.
 Fluid volume deficit related to fever, diaphoresis as evidenced by
reduced skin turgor.
 Altered nutrition less then body requirements related to loss of appetite
as evidenced by weight loss
 Activity intolerance related to decreased energy reserves as evidenced
by patients tired look