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Pulmonary Embolism; Fat Embolism
Pulmonary Embolism; Fat Embolism
Terms in this set (16)
What population of patients has the highest risk for perioperative recurrence of venous thrombos is?
The highest risk for perioperative recurrence of venous thrombosis exists for patients who have experienced thromboemboli during the previous month. Elective surgery in these patients should be deferred until a 3 month course of warfarin is completed
What is the most consistent symptom of acute pulmonary embolism?
The most consistent symptom of pulmonary embolism is sudden, acute dyspnea.
List ten (10) signs and symptoms of pulmonary embolism in the nonsurgical patient.
Ten signs and symptoms of pulmonary embolism in the nonsurgical patient are: (1) acute dyspnea, (2) tachypnea (>20 breaths per minute), (3) tachycardia (>100 bpm), (4) pleuritic chest pain, (5) rales, (6) nonproductive cough, (7) accentuation of pulmonic component of second heart sund (S2), (8) hemoptysis (suggest pulmonary infarction), (9) fever, and (10) Homan's sign (pain in calf or popliteal region with abrupt dorsiflexion of foot by examiner).
What are five (5) signs of intraoperative pulmonary embolism?
Intraoperative pulmonary embolism usually presents as: (1) unexplained sudden hypotension, (2) unexplained arterial hypoxemia, (3) tachycardia, (4) bronchospasm, and (5) decreased end-tidal CO2.
What laboratory test when positive is consistent with pulmonary embolism, but when negative strongly suggests that thromboembolism is absent?
A positive D-dimer test means pulmonary embolism is possible. A negative D-dimer test strongly suggests that thromboembolism is absent (negative predictive value >99%).
What explains an increase in peak inspiratory pressure, a decrease in end-tidal CO2, and a decrease in arterial oxygen saturation after six hours of maintenance with nitrous oxide and a volatile agent such as desflurane or isoflurane?
Obstruction in the endotracheal tube can be ruled out. because this problem is associated with an increase in ETCO2. A pulmonary embolism can explain the data. Arterial hypoxemia with hypocapnia (decreased ETC02) are generally associated with a pulmonary embolus(Barash). Bronchospasm (Morgan and Mikhail) explains the increase in peak inspiratory pressure (PIP ).
The patient is undergoing a hip replacement. ETCO2 suddenly decreases to 10 mmHg. What happened? Why?
A pulmonary embolism secondary to deep venous thrombos is or a fat embolism is possible. Emboli in the pulmonary capillaries cause an abrupt decrease in ETC02. The leading cause of death in patients undergoing total joint replacement is pulmonary embolism
What are treatments for the patient who suddenly develops pulmonary embolism?
Support cardiovascular function, give IV heparin, give supplemental O2, treat hypotension, intubate if necessary
What is the usual cause of fat embolism syndrome (FES)? When do FES symptoms usually manifest?
Fat embolism (embolus) syndrome (FES) is associated with multiple traumatic injuries and surgery involving long-bone fractures (especially femur or tibia) or pelvic fractures. FES has also been associated with acute pancreatitis, cardiopulmonary bypass, parenteral infusion of lipids, and liposuction. The syndrome usually occurs 12 to 72 hours after insult.
Which blood vessels commonly become occluded by fat emboli?
Small pulmonary arterioles
List four early signs and symptoms of fat embolism.
(2) Hypoxia, (2) diminished mental status, (3) fat globules in the urine and sputum, and (4) petechial hemorrhages
What sign strongly suggests a diagnos is of
Petechiae on the chest, upper extremities, axillae, and conjunctiva
List 4 major signs, five minor signs, and 5 laboratory features of fat embolism syndrome.
The major criteria for diagnosis of fat embolus syndrome are: (1) axillary/subconjunctival petechiae, (2) hypoxemia/respiratory insufficiency, (3) CNS depression (disproportionate to hypoxemia), and (4) pulmonary edema. The five minor criteria are: (1) tachycardia (> 100 bpm), (2) pyrexia (hyperthermia), (3) retinal fat emboli, (4) jaundice, and (5) renal changes. Laboratory features of FES and (1) fat microglobinuria (required), (2) elevated serum lipase, (3) anemia, (4) thrombocytopenia, and (5) increased erythrocyte sedimentation rate (ERS).
What triad of signs and symptoms should arouse suspension of fat embolism syndrome?
The triad of hypoxemia, mental confusion, and petechiae in patients with orthopedic insult should arouse suspicion of fat embolism
Describe the treatment of fat embolism syndrome.
Treatment of fat embolism syndrome is supportive with early resucitation and stabalization to minimize the stress response to hypoxemia, hypotension, and diminished end-organ perfusion. Immobilization of long-bone fractures and management of respiratory distress syndrome are appropriate.
What pharmaceutical agent may be administered prophylactically for patients at risk for fat embolism syndrome? Briefly describe the proposed mechanism of prophylaxis.
Prophylactic administration of corticosteroids for patients at risk of fat embolism syndrome may be useful, but the efficacy has not been clearly established. Corticosteroids may decrease the incidence of fat embolism syndrome by limiting the endothelial damage caused by free fatty acids.
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