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Acute Pulmonary Embolus in the EMS Setting
Columbia Southern University
EMS 2302
Dr. Barbara Wise
June 17, 2023
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Acute Pulmonary Embolus in the EMS Setting
Acute pulmonary embolus is a severe condition that can affect any individual at any age. According to an article published by Bob Sullivan, “It is the second leading cause of sudden death in the United States and is responsible for over 250,000 hospitalizations in the United States each year” (2017a). Pulmonary embolus is a condition that affects not only respiratory but circulation as well due to the embolus obstructing blood flow in the pulmonary artery. Given this
condition's severe nature and sudden onset, acute pulmonary embolus is a condition that all emergency medical services providers should be able to quickly recognize.
Normal Structure and Function of the Pulmonary Artery
The pulmonary artery is integral in proper gas exchange. The pulmonary artery differs from other arteries in the body in that unlike all other arteries, which carry oxygenated blood, the
pulmonary arteries carry deoxygenated blood. The pulmonary arteries “enter the lungs and branch, following the bronchi and their branches to the lobules” (Bledsoe et al., 2019, pp. 586). It
is here in the pulmonary arteries where blood is oxygenated and then passes through the pulmonary veins into the heart and is then circulated throughout the body. Without these structures, the body would have no way in which to oxygenate blood and would in turn be unable
to provide oxygen-rich blood to the other organ systems in the body, which could then result in the death of the organ system and ultimately death of the person. Expectant Vital Signs in Patients with Acute Pulmonary Embolus
The presentation of a pulmonary embolus in any patient can be difficult to recognize. A pulmonary embolus can present with a wide variety of symptoms, many of which can mimic other, less severe, medical conditions. As with all patients, a thorough physical examination, as
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well as a proper patient history should be obtained. According to Sullivan (2017b) patients with pulmonary embolus typically present with tachypnea and tachycardia, and their skin may be pale, diaphoretic, and cyanotic. Due to this tachypnea, patients may also present with lowered end-tidal carbon dioxide (ETCO
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) levels. This can also be attributed to the decreased perfusion to
the lungs due to the pulmonary embolus obstructing blood flow through the pulmonary artery or arteries. Due to this obstruction, “low SPO
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, low ETCO
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with a normal capnography waveform and clear lung sounds strongly suggest pulmonary embolism” (Sullivan, 2017c).
Pulmonary Embolus and the Impacts of the Primary Functions of the Respiratory System
Pulmonary emboli impact the primary function of the respiratory system in that they prevent the pulmonary arteries from completing their primary function of oxygenating blood prior to its circulation through the body. According to Johns Hopkins (2021), “a pulmonary embolism can cause a lack of blood flow that leads to lung tissue damage. It can cause low blood
oxygen levels that can damage other organs in the body.” Pulmonary embolus further impacts the primary function of the respiratory system by preventing the proper levels of blood oxygenation from circulating through the body into other organ systems, which may lead to systemic organ system failure, and ultimately death of the individual.
Concepts of Pathophysiological Principles that Guide Emergency Care of Patients
Experiencing Pulmonary Embolus
By understanding the pathophysiological principles of the respiratory and cardiovascular systems, providers can improve the patient outcome of patients who are affected by pulmonary embolus. It is important to remember that while the embolus is primarily affecting the pulmonary
arteries, this condition also places stress on the right side of the heart. As blood circulates
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through the body, the blood travels in the same cycle. This cycle has been described by the National Library of Medicine A.D.A.M. Medical Encyclopedia (2022) as: Blood enters the right atrium and passes through the right ventricle. The right ventricle pumps the blood to the lungs where it becomes oxygenated. The oxygenated blood is brought back to the heart by the pulmonary veins which enter
the left atrium. From the left atrium, blood flows into the left ventricle. The left ventricle pumps the blood to the aorta which will distribute the oxygenated blood to all parts of the body.
By understanding these principles, the provider could then deduce that one should aim to improve oxygenation without adding additional stress to the already vulnerable right ventricle. This can be accomplished by providing supplemental oxygen by way of a nasal
cannula where appropriate.
Emergency Care for Patients Experiencing Acute Exacerbation of Pulmonary
Embolus
Patients who are experiencing an acute exacerbation of pulmonary embolus should be provided with rapid transport to an appropriate hospital. Patients who are experiencing a pulmonary embolus may receive several different types of treatment based
on their acuity. Treatments for pulmonary embolus, as described by Johns Hopkins (2022b), can include anticoagulants, fibrinolytic therapy, vena cava filters, pulmonary embolectomy, percutaneous thrombectomy, or any combination of the aforementioned treatments. While it is exceptionally rare that an emergency medical services provider would have any of these treatment options available on their ambulance, knowing which
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local hospitals provide these treatments is critical to the treatment of the affected patient. Treatments that can be provided to the patient in the pre-hospital setting may include proper oxygenation by way of nasal cannula, non-rebreather mask, or continuous positive
airway pressure (CPAP) device. Treatment should also include the proper management of
all associated symptoms such as hypotension, respiratory failure, or cardiac arrest. Hypotension in patients with pulmonary embolus should be treated with an intravenous vasopressor, such as norepinephrine, rather than aggressive intravenous fluid administration, according to Sullivan (2017d), as fluid administration adds stress to the already failing right ventricle.
Conclusion
Pulmonary embolus is a severe condition that can affect people of any age at any time. Pulmonary emboli are “a blood clot that develops in a blood vessel in the body (often in the leg). It then travels to a lung artery where it suddenly blocks blood flow” (Johns Hopkins, 2021c). This serious medical condition, without proper treatment, can lead to serious medical complications and ultimately, death.
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References
A.D.A.M. Medical Encyclopedia. (2022). Heart chambers; [Reviewed 2022 Apr 10]. National Library of Medicine.
https://medlineplus.gov/ency/imagepages/19612.htm
Bledsoe, B., Martini, F. H., Bartholomew, E. F., Ober, W. C., & Garrison, C.W. (2019, December). Anatomy & physiology for emergency care (3
rd
ed.)
(pp. 586). Pearson.
Johns Hopkins. (2021a-c). Pulmonary embolism. Johns Hopkins Medicine.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/pulmonary-embolism
Sullivan, B. (2017 a-d). 4 things EMS providers need to know about pulmonary embolism. EMS1
https://www.ems1.com/ems-products/capnography/articles/4-things-ems-providers-need-
to-know-about-pulmonary-embolism-4I1Wv13PRksPyI0I/
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