What Is Massive Pulmonary Embolism?

Clinicopathophysiological syndrome (PE) of pulmonary circulation disorders caused by various emboli in the systemic circulation blocking the pulmonary artery and its branches. The most common pulmonary embolism is a thrombus. Pulmonary embolism caused by a thrombus is also called pulmonary thromboembolism. Sudden collapse, unexplained paleness, cold sweats, dyspnea, chest pain, cough, and other symptoms of hypoxia such as extreme anxiety, burnout, nausea, convulsions, and coma occurred suddenly.

Basic Information

nickname: Acute pulmonary embolism
Visiting department: Thoracic and Cardiovascular Surgery

Common causes: Systemic circulation caused by various emboli shedding
Common symptoms: Sudden collapse, unexplained paleness, cold sweats, difficulty breathing, chest pain, cough, etc.

Causes of pulmonary embolism

Pulmonary embolism can be caused by the loss of various emboli in the systemic circulation. The most common pulmonary emboli are blood clots.

Source of emboli

(1) Thromboembolism Within 24 to 48 hours after surgery, peroneal vein thrombosis and pelvic vein thrombosis are important sources, which mostly occur in gynecological surgery and pelvic diseases. Thrombophlebitis can cause deep veins to form pulmonary embolism due to the continued spread of thrombus, or it can be the superficial vein thrombus to fall free to the pulmonary artery to form a pulmonary embolism.

(2) Other emboli such as fat emboli, air emboli, amniotic fluid, bone marrow, metastatic cancer, bacterial emboli, and cardiac neoplasms can cause the disease.

2. Conditions of venous thrombosis

(1) Stasis of blood flow.

(2) Injury of vein wall.

(3) Hypercoagulable state.

Clinical manifestations of pulmonary embolism

According to the size of the emboli and the degree of occlusion of the pulmonary artery, the clinical manifestations are divided into two parts:

Main performance

A series of manifestations including sudden onset and cerebral hypoxia.

Sudden onset of the disease, the patient suddenly suffered unexplained collapse, pale, cold sweats, dyspnea, chest pain, cough and other symptoms, and even syncope and hemoptysis. Cerebral hypoxia symptoms: The patient is extremely anxious, fearful, nauseous, convulsed, and unconscious. Acute pain: chest pain, shoulder pain, neck pain, anterior heart area and epigastric pain. In short, the performance varies depending on the size of the emboli and the location of the obstruction, but syncope may be the only or first symptom of acute pulmonary embolism.

According to clinical manifestations, they can be divided into sudden death type; acute cardiogenic shock type; acute pulmonary heart disease type; pulmonary infarction type; sudden unknown cause type.

2. Signs

Large arterial embolism can show symptoms of acute right heart failure and even sudden death. Tachycardia, even diastolic galloping, second hypertensive pulmonary artery sounds, second atrial fissures in aortic and pulmonary valves, shock, cyanosis, jugular vein distension, and hepatomegaly. Wet lung sounds, pleural friction sounds, wheezing sounds, and signs of lung consolidation.

Pulmonary embolism

ECG, blood gas analysis, D-dimer, and intravascular thrombus examination under ultrasound.

Diagnosis of pulmonary embolism

According to clinical manifestations and related examinations, electrocardiogram, echocardiography, D-dimer, arterial blood gas, radionuclide lung ventilation scan, and CTPA can assist diagnosis or confirm the diagnosis.

Differential diagnosis of pulmonary embolism

The clinical and chest X-ray changes of this disease often need to be distinguished from acute myocardial infarction, aortic dissection aneurysm rupture, and pneumonia.

Pulmonary embolism treatment

1. The disease is urgent and needs emergency treatment.

(1) Absolute bed rest, high concentration of oxygen inhalation.

(2) Place the central venous pressure catheter, measure the central venous pressure, and control the infusion volume and speed.

(3) Analgesia. Subcutaneous injection of morphine is available for severe chest pain. Avoid use in shock.

(4) Anti-shock treatment.

(5) Antispasmodic.

2. Anticoagulant therapy

Corresponding anticoagulant therapy was given, and the international standardized ratio was monitored to be stable at 2.0 to 3.0, or anticoagulant therapy was maintained after thrombolytic therapy according to the size of the embolization area and vital signs of the patient.

3. Surgical treatment

(1) Pulmonary embolectomy This method has a high mortality rate, but can save the lives of some patients, and must strictly grasp the indications for surgery.

(2) Vena cava occlusion is mainly to prevent recurrence of embolism. Methods include surgical clips, umbrella-shaped devices, mesh screening, and folding.

Pulmonary embolism prevention

1. Early detection of deep venous thrombosis of the lower limbs

Most patients can prevent the occurrence of pulmonary embolism. To prevent venous thrombosis:

(1) The operation should be gentle and meticulous to reduce tissue damage. Dehydration should be corrected in time during delivery to prevent increased blood coagulation.

(2) Get out of bed early to promote blood circulation and enhance blood circulation.

(3) Apply preventive anticoagulant therapy if necessary.

2. Drug anticoagulation to prevent thrombosis

(1) Small dose of heparin.

(2) Oral anticoagulants.

(3) Antiplatelet preparations.