Risk Factors
Virchow triad: venous stasis, endothelial injury, hypercoagulability. Risk: immobility, surgery, malignancy, pregnancy, OCP, thrombophilias, obesity, smoking. DVT embolizes to pulmonary arteries.
Clinical Presentation
Classic triad: dyspnea, pleuritic chest pain, hemoptysis (all three in only 20%). Tachypnea, tachycardia, hypoxia. Massive PE: hypotension, right heart strain, syncope, cardiac arrest. CT angiography gold standard.
Nursing Management
Anticoagulation immediately: heparin drip or LMWH, then warfarin/DOAC 3-6 months. Massive PE: thrombolytics (tPA) if unstable. Monitor BP, HR, SpO2, bleeding signs. Bed rest initially. IVC filter if anticoagulation contraindicated.
Important Notes
- Patient on heparin with new tachycardia and hypotension may have massive PE — call for help.
- Never massage calves of patient with suspected DVT — embolus dislodgement can be fatal.
Clinical Tips
- If D-dimer normal in low-risk patient, PE effectively ruled out.
- Bridge heparin to warfarin until INR therapeutic for 2 consecutive days.
Summary
Pulmonary embolism requires immediate anticoagulation, hemodynamic monitoring, and assessment for thrombolytic therapy in massive PE.
