Pulmonary Embolism

[LilMissAlwaysCurious]

Is it OK for a patient who has PE to use Incentive Spirometer?

[leslie :-D]

yes, absolutely.

deep breathing, coughing, and incentive spirometers, are key elements of rehab.

anyone with pulm dysfunction, needs to focus on expanding lungs and regaining volume.

is there any reason you would think otherwise?

leslie

[LilMissAlwaysCurious]

thanks leslie. i was use concerned that maybe the patient will throw off the clot when they do IS.

[nurseprnRN, BSN, RN]

and where do you think it will go? if you say, "to their brain and cause a stroke" then please review normal anatomic blood flow. this starts at the deep vein the clot probably started in, but it will help you out.

body > veins > vena cava > right atrium > tricuspid valve > right ventricle > pulmonic valve > pulmonary artery > [color=#ee82ee]lungs >pulmonary vein > left atrium > mitral valve > left ventricle > aortic valve > arteries > body

the only way a venous dvt can get to the cerebral arterial circulation is if there is a direct connection between the venous side and the arterial side in the heart and the venous pressure is higher than the arterial pressure.

anyone with an atrial or ventricular septal defect and a right-to-left shunt, who would be at risk for arterial embolu of venous origin, and this would be bad. however, since in most people, the left heart pressures are significantly higher than right heart pressures (by a factor of five to ten, more or less), any air or clot in the right heart keeps going right on out the pulmonary artery to the capillary bed, where it gets strained out and stuck; if it's big we call it a pe, but you make small ones every day without knowing it (did you know heparin is made in lungs? hmmm).

unsuspected asds are a known cause of stroke in younger people who lack other risk factors-- think of the much-beloved erstwhile heart and soul of the patriots' line, tedy bruschi, whose stroke fortunately resolved and whose asd was repaired endoscopically; he went back to football for the rest of that season and the next one (although he has since retired). as a matter of fact, most asds are found by accident or on post for unrelated issues, since the left-to-right shunt doesn't do much harm unless it's so huge that you get bad pulmonary hypertension and capillary bed damage (seen in single ventricle, for example).

a pe won't go anywhere. it can't. it's too big to pass through pulmonary capillaries.