20 PE

Pathogenesis

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• femoral vein: thigh

• popliteal vein: behind knee

• edema from poor venous outflow

Symptoms

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• worse with deep breath

• sudden death: so much obstruction of blood flow that dies from shock

Diagnosis

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• CT contrast

• thrombus in pulmonary artery

• large PE crossing bifurcation

• saddle emboli

• pt likely to be in shock

• classic EKG

• deep S wave in lead 1, Q wave and inverted T wave in lead III

• pseudo RBBB in V1, lower right: normal

• sign of right heart strain: massive PE

• in clinical practice and ER

• blood clots present and broken down by coagulation system: raise D-dimer

• for ruling out DVT/PE with low Wells score

• inhale nuclear tracer: left

• inject nuclear tracer: right

• see difference in V/Q

Treatment

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• similar causes and treatment to PE

• together aka VTE

Fat Embolism

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• fat in bone marrow leak out

• triad of symptoms in lung, CNS, skin

• lung: respiratory failure

• looks like ARDS

• pt after trauma present with dyspnea, confusion, petechiae

Amnionic Fluid Embolism

_..

• women shortly after delivering baby develops symptoms

• biopsy shows fetal squamous and keratin debrid

• seizure can be seen in phase 1 or 2