Pulmonary Embolism | Knowledge is Power

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by EOC EOC

Specializes in ICU.

Know your risk factors. Make prevention your goal.

Pulmonary Embolism: What you should know

Pulmonary Embolism | Knowledge is Power

What you should know about pulmonary embolism 

  • What can cause PE 
  • The risk for PE 
  • Symptoms of PE 
  • Treatment of PE 
  • Things you can do 

Overview 

Our circulatory system is made up of veins and arteries that move blood and plasma throughout our body to deliver oxygen and nutrients. Blood clots can be found anywhere in the body. The blood clot that forms (thrombus) can break off and create an embolism (a blood clot or foreign body) that travels through the body to the lungs. A sudden disruption of blood flow and oxygen can cause damage to the lungs and other organs in the body. In the United States, approximately 1-2 per 1000 individuals develop a Veno thromboembolism (that includes DVT and PE). A pulmonary embolism can be extremely serious and can even cause death.  

What can cause PE? 

The blood clotting mechanism is a normal process of our body. There are two parts, blood clotting and breaking down of blood clots. At times, the system may not work as it should. When that happens, bleeding can occur or the formation of clots. A pulmonary embolism most commonly results from thromboembolism. That is where part of the thrombus (clot) becomes dislodged, usually in a lower limb, and makes its way to the lungs.  

The risk for a PE

Conditions that place individuals at risk:  

  • Surgery -   orthopedic surgery (fat embolism) 
  • Pregnancy 
  • Cancers  
  • Lung diseases (COPD, cancer) 
  • Cardiovascular disease (Heart failure) 
  • Genetics 
  • Immobility (extended periods of bed rest and long trips can place you at higher risk of DVT) 
  • Obesity 
  • Hormone replacement therapy, birth control (can affect clotting mechanism) 
  • Age - increased risk after age 40 
  • Varicose veins 
  •  Infections, Covid – 19 
  • Cigarette smoking 
  • Injury to a vessel or infection can irritate the vessel wall and can create a thrombus. Other causes of pulmonary embolism can be air or amniotic embolism, broken-off pieces of a tumor, or fat emboli from a broken bone.  

Symptoms of PE 

If you have any seek medical attention at once.  

  • Shortness of breath with or without sudden onset 
  • Feeling anxious, impending doom 
  • Chest pain (may worsen with breathing) 
  • Irregular heart rhythm  
  • Coughing up blood 
  • Hypotension 

Treatment of PE 

Developing a pulmonary embolus can be alarming. Getting medical attention and treatment should be done asap. Diagnosis of PE can be difficult. Having a thorough history and physical is always important in the identification of any condition. Confirmation of a pulmonary embolism can be done by lab work and or various testing. Some of the tests ordered may be; chest x-ray, CT scan, MRI, or V/Q scan  

Anticoagulation is the usual first-line treatment. They prevent the formation of new clots while your body is breaking down the clots you have. Heparin is the usual drug of choice unless you have an adverse effect. Heparin can be given by IV or subcutaneous routes. Coumadin or Arixtra are some other options that can be used. Consult with your physician on which treatment and the length of treatment will work best for your condition. 

Thrombolytics are used to dissolve the clots that are already there. Most deaths occur within an hour of symptoms of severe hypotension from PE. Alteplase (tPA) is used most often for severe complications of PE. Streptokinase and urokinase also may be used. Bleeding is a complication in the use of these drugs. Monitoring for 24 hours post-infusion is standard care.  

Thrombectomy is used for unstable PE. The patient is taken to interventional radiology to extract the clot from the vessel being obstructed. 

IVC filter (inferior vena cava filter) Is placed to catch most clots that are in your lower extremities from traveling to your lungs. It doesn’t stop any new clots from building up.  

Things you can do: 

  • Exercise 
  • Eat a balanced diet 
  • Don’t sit for extended periods of time 
  • Wear support stockings 
  • Drink fluids to avoid dehydration.  

Summary: 

A pulmonary embolism can become a life-threatening condition. Approximately one-third of people undiagnosed with pulmonary emboli have a fatal outcome. Treatment of pulmonary embolisms can be done with blood thinners. Treatment with anticoagulants needs to be checked closely because of the elevated risk for bleeding. When found early most pulmonary embolisms can be treated successfully. Another treatment to remove the clot is a thrombectomy. Be aware of your risk factors. Know your family history. Ask your physician what your risks are and develop a plan to help reduce them. Make prevention your goal. 


References

Pulmonary embolism Hopkins Medicine

Pulmonary embolism: Mayo Clinic

American Society of Hematology 2020 guidelines for management of venous thromboembolism 

Treating and Managing Pulmonary Embolism | American Lung Association 

Update on Thrombolytic Therapy in Acute Pulmonary Thromboembolism - PMC (nih.gov) 

EOC

Eileen O'Connor MSN, RN CCRN-K

1 Article   17 Posts

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5 Comment(s)

Bonnie B. VerHeecke

Bonnie B. VerHeecke

Specializes in Nurse Practitioner. Has 45 years experience. 1 Post

Well written article for nurses and the general public. 

GracefullyGritty, LPN

Specializes in wound care/rehabilitative care. Has 6 years experience. 18 Posts

Very good read. You missed one item in the risks for development; we have a score of patients that did get the Covid shots, develop a PE. The science also proves this. 

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience. 142 Articles; 9,964 Posts

I recently had an experience with PE myself.

I had fallen and broken my right ankle, and of course it had to be casted and non-weight-bearing status ordered. A few weeks later, I noticed some peculiar symptoms like wheezing (which I attributed to my asthma) a cough, and some mild SOB. I wasn’t sick, so where this was coming from I had no idea.

Then the chest pain and major shortness of breath arrived as I was getting in the car with my son. It took me 20 minutes or so to get my breath back and the chest pain to fade, so Miss Smarty Pants Nurse decides she wants to stay home and tells her son, who is a nurse himself, to let her out of the car. He says “No, Mom, you’re going to the ER”. “No I’m not.” “Yes you ARE.” And with that, off we went.

It didn’t really take long for the doctors to figure it out: pulmonary embolism. Saddle PE, to be exact. They explained to me quickly what that meant, put me on oxygen (my sats were in the low 80s) and a heparin drip, and took me up to the stepdown unit where a nurse, a tech and a respiratory therapist were waiting. Telemetry was applied, bed alarm (!) was initiated, and the assessment was done.

They did a deep-vein ultrasound on my good leg and found a DVT, but couldn’t do the lower right leg obviously because of the cast. They did an echocardiogram, which showed remarkably good heart health for someone in my condition. Vitals, blood draws etc. every 2 hours were a pain, but I was only too happy to let them do it. I could have died. I wasn’t going to complain about such trivialities. 
 

Anyway, I learned a lot about PE and why it happens. I don’t ever want to go through anything like it again, so I’m making a few changes like eating a little less and doing my PT exercises. I still feel kind of on edge, because I know the emboli are still there, but I’ve got meds to keep any more from forming, and these will dissolve with time. 😊

EOC

EOC

Specializes in ICU. 1 Article; 17 Posts

So glad you listened to your son and went to the ED. I work in the ICU and we see this scenario all too often. Having mild symptoms makes it so much more difficult to decide if you need medical help or not. I tell patients that are having CP, wouldn't it be better to go home with heartburn than not going home again.  So glad you're okay!

EOC

EOC

Specializes in ICU. 1 Article; 17 Posts

Thank you for your reply. I had listed Covid 19 as a condition that places you at risk for PE. Yes, there are studies on vaccines and blood clots. The Johnson and Johnson vaccine, I believe is the one most attached to the blood clot issue. I hope in the next few years we learn a lot more about them and have better treatments for sure. I lost my niece at 38 from Covid. She was a beautiful woman. She was overweight and had asthma. She chose not to get the vaccine. In rehab, I'm sure you see a lot of post covid issues too. I dread the thought of another round of covid.