Acute Pulmonary Thromboembolism
Subadhra Devi. M1, Cecily Ruba2, Mahalakshmi3
1Nursing Supervisor, Kauvery Hospital, Cantonment, Trichy
2Nurse Educator, Kauvery Hospital, Cantonment, Trichy
3Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy
Background
A pulmonary embolism is a blood clot that blocks and stops blood flow to an artery in the lung. In most cases, the blood clot starts in a deep vein in the leg and travels to the lung. Because one or more clots block blood flow to the lungs, pulmonary embolism can be life-threatening.
Objectives
Identify clinical signs and symptoms indicative of acute pulmonary embolism to facilitate prompt diagnosis and intervention.
Case Presentation
A 44-year-aged male patient came with complaints of breathing difficulty, sudden profuse sweating, and giddiness followed by fall and loss of consciousness (LOC).
The coworker found the patient and brought him to the hospital. The ER doctor did echo screening; it showed a high probability of pulmonary embolism. The patient was very unstable to be shifted for CT Pulmonary Angiogram (CTPA), which is the gold standard investigation for pulmonary embolism
Echo of Pulmonary Artery
- The main pulmonary artery is enlarged (diameter > 25 mm), suggestive of increased pressure.
- Color Doppler reveals turbulent flow in the right pulmonary artery.
ECG: Electrocardiograph findings are consistent with acute pulmonary embolism, characterized by right ventricular dilation, hypo kinesis, and elevated pulmonary artery pressures.
X-ray: Normal
ABG
- PO2 – 70
- PCo2 – 40
- Ph – 7.50
We received the patient in critical situation, without blood relations. Through phone call patient’s condition was explained to his wife. We requested her to visit the hospital; within 10 min his wife was in the hospital. We explained his condition and evolution of the disease to her. She became very emotional, and found it difficult to handle the situation, on fearing her dear one is at the verge of collapse, whom she saw well in the morning, going to his routine work.
In the meantime, cardiologist was consulted who planned for emergency thrombolysis for Pulmonary Thromboembolism. After starting thrombolysis, within min the patient became unresponsive, with no carotid pulse. CPR was started as per ACLS protocol. The complete dose of Inj. Alteplase was administered as per order.
We stood by the side of the patient’s wife, explained to her and gave hope that we are working hard to revive him. After 3 cycles of CPR and thrombolysis, spontaneous circulation (ROSC) was returned.
Each and everyone in the resuscitation team participated in trying to revert the patient. After 30 min patient regained consciousness and started obeying commands. We felt very happy on seeing the relief on the wife’s face. Seeing relief or happiness in a patient’s relative gives us the boost to work harder.
Then patient was shifted to Heart City CCU with multiple supports.
On the day 2 patient was on continuous mechanical ventilator and weaned from inotropes support
On the 3rd day patient was weaned from the ventilator; all parameters were normal, and he tolerated with O2 mask
On the 4th day he was on room air and mobilized
Nursing Interventions (Post Thrombolysis Care)
- Monitor Vital Signs: Regularly assess blood pressure, heart rate, respiratory rate, and oxygen saturation to detect any signs of instability or complications.
- Neurological Assessment: Perform frequent neurological checks to identify any signs of intracranial hemorrhage, such as changes in consciousness, speech, or motor function.
- Assess Bleeding: Monitor for any signs of bleeding, including bruising, hematuria, or gastrointestinal bleeding. Check the puncture sites for bleeding or hematoma formation.
- Maintain IV Access: Ensure that IV access is patent and monitor for signs of infiltration or phlebitis, especially if heparin or other anticoagulants are being administered
- Administer Medications: Administer anticoagulants as prescribed, and ensure that the timing of doses is appropriate post-thrombolysis.
- Fluid Management: Monitor fluid intake and output to prevent dehydration and maintain adequate hydration.
- Education: Provide education to the patient and family about signs of complications, the importance of follow-up care, and lifestyle modifications to reduce future thromboembolic events.
- Bed Rest: Encourage bed rest as ordered, especially in the first few hours’ post-thrombolysis, to minimize the risk of bleeding and allow for recovery.
- Emotional Support: Offer emotional support and reassurance to the patient and family, addressing any concerns they may have regarding the procedure and recovery.
- Document Care: Maintain accurate documentation of assessments, interventions, patient responses, and any changes in condition to ensure continuity of care.
Discharge
On 5th day patient was successfully discharged from the hospital
Prevention of PTE
- Stay Active: Engage in regular physical activity, especially during long periods of immobility, like long flights or car rides.
- Hydration: Drink plenty of fluids to maintain good blood circulation and prevent dehydration, which can increase clot risk.
- Compression Stockings: Use graduated compression stockings during long travels or post-surgery to promote blood flow in the legs.
- Leg Exercises: Perform leg exercises, such as ankle pumps, to encourage circulation while sitting or lying down.
- Maintain Healthy Weight: Achieve and maintain a healthy weight to reduce the risk of venous stasis and clot formation.
- Avoid Smoking: Quit smoking, as it increases the risk of clot formation and vascular problems.
- Medication Management: Follow your doctor’s advice on anticoagulants if you have risk factors for thrombosis.
- Monitor Hormonal Treatments: Be cautious with hormonal therapies (like birth control pills or hormone replacement therapy) and discuss risks with your doctor.
- Post-Surgery Care: Follow post-operative guidelines, including early mobilization and possibly anticoagulation therapy if recommended.
- Know the Signs: Be aware of symptoms of deep vein thrombosis (DVT) and PE, such as swelling, pain in the legs, shortness of breath, or chest pain, and seek immediate medical attention if they occur.
Conclusion
In cases, where PE is identified and treated promptly, patients often experience complete resolution of symptoms and restoration of pulmonary function. Long-term management, including appropriate anti-coagulation and lifestyle modifications, is essential to prevent recurrence. As our understanding of risk factors, pathophysiology, and management continues to evolve, ongoing education and awareness among health care providers and patients remain paramount. This will ensure that pulmonary embolism is recognized and treated efficiently, ultimately improving patient care and outcomes.
Ms. Subhahra Devi. M
Nursing Supervisor
Ms. Cecily Ruba
Nurse Educator
Ms. Mahalakshmi. B
Nursing Superintendent
