 Hello, welcome and thank you for watching Nursing School Explained. Today's topic is pulmonary embolus or PE. So let's look at the pathophysiology behind a PE. So remember that the thrombus is the blood clot that is on the move where an embolus is a blood clot that has become stagnant or dislodged somewhere. So for a pulmonary embolus that is a thrombus that is now dislodged in the pulmonary artery it can so it's it's a thrombus but it can also be a fat or air embolus or tumor. So basically what a fat embolus is that usually happens after long bone fractures when let's say the femur breaks. Bone marrow is released, some fat enters the bloodstream and then it can become dislodged in the lungs where an air embolus is basically the mishandling of an IV line. So now air has gotten the patient's IV line, it travels up the vasculature and then this air does not allow blood flow to the lungs and their flow for it becomes obstructed and certainly tumors can cause that as well. But the most common cause of pulmonary embolus is DBT, deep vein thrombosis that becomes dislodged and is now entered the pulmonary artery and is causing some major problem with ventilation and perfusion. Other causes are atrial fibrillation. Remember that when the atria they just quiver and there's a lot of swishing around of the blood in the atria the patient is more prone to clots it can become dislodged and then get into the pulmonary artery as well as pelvic veins after surgery. So any kind of abdominal surgery puts the patient at higher risk for a clot that forms in the pelvic veins. Now risk factors because we know the most common one is DVT so it's immobility right that's a high risk factor for for DVT or surgery in the last three months also patients with a history of DVT are more prone to get more DVTs smoking certainly is a risk factor as well as obesity which kind of goes along with the immobility birth control pills have a higher risk for blood developing blood clots air travel so being sedentary at high elevations for a long period of time and also immobilized can put patients at risk for PE as well as heart failure pregnancy due to due to the increase of blood volume that the mother goes through when she is trying to nourish the fetus as well as patients with clotting disorder certainly they're going to be at higher risk for an embolus. So signs and symptoms so just think about if there is now a blood clot obstructing the pulmonary artery the blood flow to the lungs certainly the patient is going to be short of breath they might be complaining of chest pain they might be mildly or moderately hypoxemic and it all depends on the size and the location of that pulmonary embolus they might have tachypnea so increased respiratory rate as well as cough as well as tachycardia they might have an episode of syncope they might have a fever they might have hemoptysis so bloody sputum in the cough crackles as well as wheezing can be lung sounds that are commonly heard and if it's a massive PE that's also called a saddle PE and that would basically be a blood clot that is so big that it obstructs the lungs at the bifurcation and does not allow blood flow into either one of the right or left lungs and when it's that massive the patient certainly will have altered level of consciousness because now we're not having any perfusion and oxygenation it can cause hypotension as well as impending doom so impending doom basically just means the patient knows that something is very wrong with them and they think that if you're not going to help them they are going to die very shortly and they will let you know about that so then complications of pulmonary embolus includes pulmonary infarction just like a clot can obstruct the coronary arteries causing a myocardial infarction a PE a pulmonary embolus a blood clot stuck in the pulmonary artery can cause pulmonary infarction because now the tissues past that clot do not get any perfusion and blood flow and therefore the tissues will die it can also cause pulmonary hypertension that is usually when there's an obstruction by that blood clot that affects more 50% of the lungs and then the the the rest of the pulmonary vasculature will get so backed up that hypertension or high blood pressure evolves there now for diagnostic tests a D-dimer is always a good blood test to check if you're suspecting pulmonary embolus but keep in mind a D-dimer is a very non-specific test for clotting so a D-dimer might be elevated for a multitude of other reasons but it's a good screening test if the patient presents with any of these signs and symptoms and maybe they have risk factors of surgery let's say then a D-dimer would be a good test now a CT scan of the test with IV contrast is pretty much the gold standard to diagnose a pulmonary embolus because by injecting the dye in the IV now we can see how is the dye spreading through the lungs and we can see if there's an obstruction whether it's partial or complete or how big the problem area is now I also wrote down here a VQ scan and that's called a ventilation perfusion scan don't ask me why that's not a P I didn't invent it it's called a ventilation perfusion scam and it is a nuclear medicine test where the patient instead of the IV contrast gets injected radioactive dye and a lot of times they also ingest it and then by the way that these nuclear isotopes make their way through the body sorry not ingested inhaled inhaled radioactive isotopes so that way we can see again how is the pulmonary vasculature responding to these isotopes but this test is very time intensive it's very specialized and it's usually only used if the patient is allergic to IV dye or they can't have a CT scan because of radiation exposure that an example would be a pregnant woman who has now a suspicion for a P E and then certainly because we're going to have we're going to have to think about dissolving that cloud so our PT AP TT our coagulation times intrinsically and extrinsically are going to be important to know and assess beforehand before we give these patients any kind of anticoagulants now if the patient is in respiratory distress we certainly would want to check an ABG as well as an EKG to see the effect that that pulmonary embolus has now maybe caused on the heart we might also want to check cardiac markers such as proponent CK CK MB and a BNP to see if there's any cardiac reasons for the patient's symptoms to rule out P but also in addition to see if we know that it's a P has it caused any extra strain on the heart or maybe not put the patient in heart failure because of all these problems with the circulation to the lungs now nursing care related to pulmonary embolus is to prevent we know that it's the most common reason for pulmonary embolus so we should prevent it to begin with and that is by doing all these good things that we do for patients that are post-op so maybe they're going to need O2 administration coughing deep breathing use of the incentives parameter as well as SCD so a sequence of compression devices that help promote blood flow from the lower extremities as well as early mobilization so getting them up getting them moving if even if it's just in the chair or to walk to the restroom it's going to help prevent dbt now for assessing we definitely want to want to assess the patient who has a PE very frequently look at their vital signs because we know they can have tachypnea tachycardia maybe low blood pressure as well as their O2 sat is going to be a good indication as to how well they're perfusing as well as an EKG or telemetry monitor to check the cardiac rhythm and then certainly want to assess lung sounds frequently to see if there have been any changes now for medications the patients will be on some sort of an anti coagulant again depending on the size and location of the pulmonary embolus and the severity of symptoms that the patient is having now usually if the patient is hospitalized they will be on heparin either IV or subq or they can be on low venox subq and then we want to while they're at the hospital prepare them for anti coagulation at home because this is a medication that the patient most likely has to be on for several weeks maybe even months to lower their risk of complications from that and so while they're at the hospital they're still going to be transition for PO medications whether that is Coumadin or eliquid or Pradaxa or whatever these medications are that the physician has decided based on the patient's other medical conditions preferences and so forth now if this is an acute PE so this is a patient who is acutely ill acutely short short of breath now we know that we have a pulmonary embolus that is majorly obstructing their lungs we have to act quickly to prevent this pulmonary infarction and the lung tissue from dying so the treatment is either thrombolytics and you might be familiar with that from strokes or maybe even MI because when the patient when there's no cath lab close by the patient has to get thrombolytics and that's usually TPA which is tissue plasminogen activator and that's just a name of the thrombolytics and those are basically the clot busting medications so those are medications that will dissolve that fibrin clot and help break it down and therefore hopefully the patient's symptoms will resolve and then there's also surgical measures which is pulmonary thrombolectomy so this is basically surgical removal of that pulmonary embolus which is of course a huge undertaking in the big surgery that the patient will have to undergo. So in conclusion remember the PE is most likely caused by DVT so we need to do all those measures that help us prevent deep vein thrombosis by early ambulation incentive spirometer use making sure the patient moves making sure those SCDs are in place and if they've had surgery most likely the patient will be on a preventive anticoagulant such as lobenox so that they don't develop the DVT that then can lead to PE or pulmonary embolism. So thank you for watching this video please also refer to the other videos in my respiratory disorder playlist and I hope to see you again sometime soon. Thanks for watching!