Pulmonary Embolism and DVT
Venous thromboembolism: prevent it, recognize it, act fast
Virchow's triad
- Stasis: immobility, long travel, HF, A-fib.
- Vessel injury: surgery (especially hip/knee), trauma, central lines.
- Hypercoagulability: cancer, pregnancy and postpartum, estrogen (pills, HRT), smoking, obesity, inherited clotting disorders, previous VTE.
DVT signs
- One-sided calf or thigh swelling, pain, warmth, redness.
- Diagnose with compression ultrasound.
- Homans' sign is unreliable: don't rely on it.
- Never massage a leg with a suspected clot.
Pulmonary embolism
Signs
- Sudden dyspnea and tachypnea (most common).
- Pleuritic chest pain, tachycardia, anxiety or sense of doom.
- Cough, hemoptysis, hypoxemia, low-grade fever.
- Massive PE: hypotension, syncope, JVD, cardiac arrest (PEA).
Tests
- CT pulmonary angiography; V/Q scan if contrast can't be used.
- D-dimer: a normal result helps rule PE out when risk is low; a high result is non-specific.
- ABG: hypoxemia with respiratory alkalosis early. EKG: often sinus tachycardia.
Nursing actions if PE is suspected
- Stay with the patient; call for help (rapid response).
- Raise the head of bed; give oxygen.
- Vital signs, SpO₂, IV access; prepare for tests.
Treatment
- Anticoagulation: heparin or LMWH, or a DOAC (apixaban, rivaroxaban) from the start.
- Thrombolytic for massive PE with hypotension (if no contraindication).
- Catheter-directed treatment or surgical embolectomy in selected cases.
- IVC filter only if anticoagulation isn't possible.
Prevention
- Early ambulation; ankle pumps and leg exercises.
- Sequential compression devices (not on a leg with a known clot).
- Pharmacologic prophylaxis: enoxaparin or SC heparin as ordered.
- Hydration; avoid crossing legs, pillows under knees, tight garments.
Priority
A post-op or immobile patient with sudden shortness of breath and chest pain has a PE until proven otherwise. Act first, then document.