Pulmonary embolus - Queensland Ambulance Service

Clinical Practice Guidelines:
Respiratory/Pulmonary embolus
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Date
April, 2016
Purpose
To ensure consistent management of patients with Pulmonary embolus.
Scope
Applies to all QAS clinical staff.
Author
Clinical Quality & Patient Safety Unit, QAS
Review date
April, 2018
URL
https://ambulance.qld.gov.au/clinical.html
This work is licensed under the Creative Commons
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International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Pulmonary embolus
April, 2016
Pulmonary embolus (PE) most commonly originates from a deep
venous thrombus (DVT ) of the lower limbs.[1] Clinical presentation
ranges from asymptomatic to sudden death caused by a massive
embolus.[2]
Clinical features (cont.)
UNCONTROLLED WHEN PRINTED
A significant proportion of patients with PE will present with
evidence of DVT, however it should be kept in mind that the
condition can be caused by other emboli, such as fat, air and
amniotic fluid.[3]
Other features:
• Cough
• Haemoptysis
• Low grade fever > 37.5°C
• Signs of DVT
UNCONTROLLED WHEN PRINTED
Cardiac instability is caused by right ventricular failure due to a massive PE with resultant shock.[1] IV fluid boluses should be
administered judiciously (see flowchart), as aggressive fluid
resuscitation may cause further overstretching of an already expanded and failing right ventricle.[4]
- unilateral swelling
- redness; localised warmth
- tenderness
- most often presenting in lower limbs
• Signs of right ventricular dysfunction[6]
UNCONTROLLED WHEN PRINTED
Clinical features
- S1-Q3-T3
- right bundle branch block (RBBB)
The clinical features of PE are varied and non-specific.[5]
Common features:
• Dyspnoea
• Jugular venous distension
• Cyanosis
• Sinus tachycardia
UNCONTROLLED WHEN PRINTED
• Shock or hypotension.
• Tachypnoea
• Pleuritic, or substernal chest pain
• Syncope or near-syncope.
Figure 2.53
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Risk assessment
CPG: Paramedic Safety
• History of a DVT or PE
CPG: Standard Cares
• Prolonged immobilisation
• Recent surgery, trauma, or hospitalisation
UNCONTROLLED WHEN PRINTED
• Oral contraceptive use
• Hormone replacement therapy
• Cancer
Consider:
Is the patient presenting with cardiovascular instability?
• Pregnancy (the risk is higher during the postpartum period, particularly after a caesarean section).
N
• Oxygen
• Differential diagnosis
• Analgesia
Y
UNCONTROLLED WHEN PRINTED
• Anticipate further deterioration and commence
resuscitation as required
• Oxygen
UNCONTROLLED WHEN PRINTED
• 12-Lead ECG
Differential diagnoses for a PE include:
• AMI
• Pneumonia
• Pericarditis
Consider:
• Differential diagnosis
• IV fluid (adult: 250–500 mL, child: 10 mL/kg )
Transport to hospital
Pre-notify as appropriate
• Adrenaline (epinephrine)
UNCONTROLLED WHEN PRINTED
• CHF
• Pleurisy
• Pneumothorax
• Pericardial tamponade
Note: Officers are only to perform procedures for which they have received specific training and authorisation by the QAS.
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