Pulmonary Embolism

Pulmonary embolism • Associated with hyper-coagulation state (protein C and S deficiency ), trauma, prolonged bed rest • High M&M • Pathophysiology: o Pulmonary arteries obstruction → ↑ dead space ventilation → hypoxemia , hypercarbia o ↑ PVR, Bronchospasm o RV dysfunction and arrhythmias • Pt may present to the OR for emergency surgery, insertion of IVC filter or surgical embolectomy • Also Pt may present with previous history of PE, and now anticoagulated → have a hematology consult (Q: risk/benefit of holding meds pre-op) also discuss with the surgeon regarding continuing the anticoagulation med periop • Have PT, PTT, and PLT count (HIT) • Better to avoid Neuraxial technique in those Pt

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If diagnosis is in doubt → Spiral CT, V/Q scan, Echo S/S → SOB, syncope, hemoptesis, tachypnea, fever P/E → look for S/S of RV failure and pul HTN Consider pneumatic compression device, and elastic stocking peri-op IVC filter can be done under LA GA: o Art-line, CVP, PAC??, TEE o Have inotrops support ready o Avoid myocardial depressant drugs o Avoid things that may ↑ PVR→ hypoxia, ↑PCO2, acidosis, hypothermia o Look for ↓ ETCO2, ↑ PCO to ETCO2, hypoxemia