Pulmonary Embolism Essay

INTRODUCTION :

I hereby present to you a case study on pulmonary embolism( PE), in which includes details of the patient , current problems and management taken place while caring for the patient .

Present compalints:
A 65 year old female with chest pain, acute shortness of breath, cough and swelling on the surgical limb.

Detail history of presenting complaints:

Mrs Blue, a 65 year old female who presents with chest pain and shortness of breath, underwent bilateral total knee replacement under general anesthesia , had video laryngoscope for intubation and was initially admitted in intensive care for close observation. The surgeon ordered to withhold DVT prophylaxis until the next day due to high volumes of haemoserous output
It could also come from the upper extremity veins or from the renal or pelvic areas in few instances. Pulmonary emboli are often times, multiple which could affect the lower lobes than the upper lobes of the lung. Deep vein thrombosis are blood clots developing in deep veins of the lower limbs can disintegrate and are carried by the circulation to the heart and eventually to the lung arteries which would result to blockage of the pulmonary artery which can be fatal. Clots is smaller form could also be found in the smaller vessels of the lung periphery which could often times cause pleuritic chest pain from the inflammatory changes in the pleura.

Clots ( eg : from deep vein thrombosis of the leg )travels through the heart to the pulmonary arteries.
The obstruction of pulmonary artery, which can be acute or chronic, is caused by three major factors such as local trauma to the vessel wall, hypercoagulability, and stasis of blood, which is commonly called as Virchow’s triad( Jarreau et al,2008) . Acute symptoms can be differentiate from chronic depending upon the onset of symptoms . For acute PE, the onset of symptoms is sudden whereas chronic PE symptoms can take place over a period of time ( Thompson and Hales,2012). Almost 75% of patients who develop PE have experienced DVT as mostly the thrombus arises from the lower limbs.( Kearon,2003).

Clinical Manifestations
CMAJ 168:183-94

9)Le Gal G, Righini M, Roy P et al (2006) Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 144: 165–71

10)Moores LK, King CS, Holley AB (2011) Current approach to the diagnosisof acute nonmassive pulmonary embolism. Chest 140: 509–18

11)National Clinical Guideline Centre (2012) Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Disease and the Role of Thrombophilia Testing. Clinical Guideline. Methods, Evidence and Recommendations. [Full version of NICE ClinicalGuideline 144].

12)National Institute for Health and Clinical Excellence (2010) VenousThromboembolism: Reducing the Risk. [Clinical guideline 92]. NICE: London

13) Seidel HM, Ball JW, Dains JE, Benedict GW (2003) Mosby’s Guide to Physical Examination. 5th edn. Mosby, St Louis

14) Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism. The Taskforce for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology. Eur Heart J 29: