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Pulmonary Embolism

Pulmonary embolism: Occurs when a thrombus, fat, air, or neoplastic tissue blocked pulmonary arteries.


Signs and symptoms

  • Sudden onset of unexplained dyspnea accompanied by anginal and pleuritic pain, exacerbated by inspiration

  • Cough

  • Crackles

  • Blood-tinged sputum

  • Mental status changes

  • Anxiety

  • Tachypnea and tachycardia


Acute interventions:

1.     Position the patient in high Fowler’s

2.     Administer oxygen as prescribed

3.     Monitor vital signs, pulse oximetry, and lung sounds

4.     Reassure the patient and maintain bed rest

5.     Prepare intubation and mechanical ventilation for severe hypoxemia

6.     Monitor ECG and ABGs

Medical interventions:

1.     Administer anticoagulation therapy (heparin) intravenously as prescribed

2.     Administer warfarin (Coumadin) orally as prescribed

3.     Narcotics for pain relief as prescribed

Surgical therapy:

1.     Pulmonary embolectomy in life threatening situation

2.     Intracaval filter

3.     Vein ligation

Main causes

  • Deep vein thrombosis (often caused by prolonged immobilization, surgery, obesity, pregnancy, and advanced age)

  • Long bone fractures may lead to fat emboli

  • Air embolism are caused by either syringe or IV inject air to a vein or arteries (e.g., dialysis, PICC)

Potential complications

  • Pulmonary infarction (death of lung tissue)

  • Pulmonary hypertension

Laboratory assessment/Diagnostic Tests

  • Monitor activated partial thromboplastin time (aPTT) for heparin therapy

  • Monitor prothrombin time (PT) and check international normalized ratio (INR) test for warfarin therapy


  • Teach the patient who are at risk regarding prevention of DVT (e.g., mobilization, use of elastic stockings, maintaining a healthy weight) – see deep vein thrombosis

  • Teach the patient regarding the hazards of anticoagulant therapy including the importance of follow up for blood tests

NB: Heparin should be started immediately unless contraindicated and continued while oral anticoagulants (warfarin) are initiated because warfarin takes approximately 3-5 days to reach its therapeutic effect.

Pulmonary embolism


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