Page 128 - Critical Care Notes

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RESP
■ Restlessness, anxiety, apprehension
■ Seizures, syncope
■ Major obstruction of the pulmonary artery → severe dyspnea, sudden
substernal pain and signs of shock, with sudden death possible within 1 hr
Diagnostic Tests
Some diagnostic tests are used to rule out other respiratory problems rather
than confirm a diagnosis of pulmonary embolism.
■ CXR, CT, MRI
■ ECG (tall, peaked P wave; tachycardia; atrial fibrillation; RBBB)
■ Echocardiogram
■ ESR, WBC
■ BNP
■ ABGs (low PaO 2 )
■ D-dimer assay: controversial diagnostic use
■ Venous ultrasonography and impedance plethysmography
· ·
■ V/Q scan
■ Pulmonary angiography
Diagnostic and Prognostic Clinical Scoring Systems
or Calculators
■ Pulmonary Embolism Severity Index (PESI simplified) interactive scoring
system can be found at http://www.mdcalc.com/simplified-pesi-pulmonary-
embolism-severity-index/
■ Well’s Criteria for Pulmonary Embolism (PE) interactive scoring system can be
found at http://www.mdcalc.com/wells-criteria-for-pulmonary-embolism-pe/
■ The PERC Rule for Pulmonary Embolism interactive scoring system can be
found at http://www.mdcalc.com/perc-rule-for-pulmonary-embolism/
Management
■ Provide oxygen by cannula, mask, or ventilator as indicated.
■ Administer heparin bolus and start heparin infusion per policy.
■ Administer sodium bicarbonate if acidotic.
■ Monitor PT, PTT, INR.
■ Administer pain medication if needed.
■ Elevate head of bed; elevate lower extremities if DVT present.
■ Assess vital signs, cardiac, respiratory and neurological status frequently.
■ Assess for cardiac arrhythmias.
■ Administer digoxin, diuretics, and antiarrhythmics as indicated.
■ Treat shock symptoms as needed with dopamine (Intropin) or dobutamine
(Dobutrex).
■ Prepare for embolectomy or vena cava filter.
■ Administer thrombolytic drug therapy: alteplase (Activase), Reteplase
(Retavase), streptokinase (Streptase), or urokinase (Kinlytic), Alteplase is
preferred, followed by reteplase.
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