Clinical features
- Small or medium PE
- Pleuritic chest pain
- Shortness of breath
- Haemoptysis in 30%
- Tachypnoea
- Pleural rub
- Coarse crackles
- Pleural effusion
- Massive PE
- Collapse
- Shock
- Cardiac arrest electromechanical dissociation
- Elevated JVP ('a' wave)
- Gallop rhythm
- Recurrent PE
- Breathlessness
- Weakness
- Syncope
- Gradual deterioration
Investigation
- Chest X-ray - oligaemic area
- ECG
- S wave in lead I, Q wave and invested T in lead III
- Right axis deviation
- Right bundle branch block
- Fibrin degredation products (FDPs) and D-dimer in blood are elevated
- V/Q scan
- Radionucleotide scan
- Demonstrates defects in perfusion of the lung in areas with normal ventilation
- Blood gases - hypoxia and low PaCO2
- Echcardiogram - high PA pressure
- Pulmonary angiography / CT pulmonary angiogram
Management
- High-flow oxygen
- Analgesia
- Intravenous heparin or
- Low molecular weight heparin
- Consider thrombolysis (rtPa)
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