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A pulmonary embolism (P.E) is a condition where a pulmonary vessel in the either or both lungs becomes blocked. The blockage is usually caused by one or more blood clots which have travelled through the venous system from another part of the body.

Commonly pulmonary embolisms are caused by a clot being transferred from smaller vessels in the leg, arm or heart (Fell, 2005). The blood clot travels around the venous system until it reaches a point where it can no longer travel freely. As a result of this, blood flow is reduced to the affected area of the lung.

Symptoms of a pulmonary embolism

Shortness of breath – the patient may struggle to complete a sentence.

Perspiration – the patient may be sweaty and clammy

Change in pallor – in severe cases of pulmonary embolism the patient may look pale and ashen.

If the blood clot is large, or the patient has not received medical assistance in adequate time, a pulmonary embolism can result in a cardiac arrest.

The following are the common presenting symptoms of a pulmonary embolism:

Diagnostic Tests

Electrocardiogram

(ECG) – ECG changes can be present in a patient presenting with a pulmonary embolism. Pulmonary embolism should not be ruled out in cases where there are no significant ECG changes. Inverted anterior T-waves on an ECG can be indicative of a P.E however this is usually in the case of a ‘massive’ embolism.

Erect chest x-ray

- In most cases of a suspected P.E a physician will request a chest x-ray. This test is unlikely to display any abnormality which will assist the diagnosis of a P.E however it can highlight other potential conditions which may be causing the symptoms.

Arterial Blood Gases –

This test involves the physician taking a small sample of blood from the radial artery. If the patient is cyanosed or hemodynamically unstable then a sample may need to be taken from the femoral artery. The blood sample is analyzed within minutes, on a machine usually available in the E.R. Arterial blood gases may be helpful in the overall assessment and management decisions of a dyspneic patient, but will not help rule in or out a P.E (Stein, 1996).

C.T Scan –

This involves a contrast dye being injected into a venous cannula, images are then taken to observe the flow of the dye through the venous system and into the pulmonary vessels. If there are any areas blocked or poorly perfused then a C.T scan will indicate this.

Pulmonary Angiography –

This test requires the insertion of a catheter into a large vein located in the groin (inferior vena cava). Contrast dye is then injected into the catheter and images of the dye are then observed to identify its course and

Because the symptoms of a pulmonary embolism can mimic other medical conditions (such as acute myocardial infarction), specific diagnostic tests are required to give a definitive diagnosis. The following tests are carried out when the patient is taken into medical care:determine any poor filling or blocked areas. Pulmonary angiography is the accepted “gold standard” test, but it is invasive and difficult to interpret, and can give false-negative results (Walling, 2003).

Chest pain – often exacerbated by taking a deep breath.

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