Pulmonary Embolism

Pulmonary Embolism is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • The majority of pulmonary embolisms (PEs) arise from thrombi in the deep veins of the lower extremities and pelvis.
  • Thrombi also originate in renal and upper extremity veins.
  • After traveling to lungs, the size of the thrombus determines signs and symptoms.

Etiology

  • Most patients with PE have identifiable risk factor:
    • Recent surgery
    • Pregnancy
    • Previous deep vein thrombosis (DVT)/PE
    • Stroke or recent paraplegia
    • Malignancy
    • Age >50 yr
    • Obesity
    • Smoking
    • Oral contraceptives
    • Major trauma
  • Hematologic risk factors:
    • Factor 5 Leiden
    • Protein C or S deficiency
    • Antithrombin III deficiency
    • Antiphospholipid antibody syndrome
    • Lupus anticoagulant

Pediatric Considerations
  • Thromboembolic disease is quite rare.
  • Risk factors in children:
    • Presence of central venous catheter
    • Immobility
    • Heart disease
    • Trauma
    • Malignancy
    • Surgery
    • Infection

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