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so moving on to the first of these
diseases pulmonary emboli these are
blood clots occluding the formerly
arterial circulation they're very common
one per person per year and where they
come from is generally speaking the
distal deep leg veins so somebody even
has a deep vein thrombosis with a clot
in one of their leg veins then that
clock can break off move up the vein
venous circulation reach the right side
of the heart and then is fired into the
lung whereas the plumie arches gets
smaller they were eventually Lodge and
caused damage distal to where it's
lodged you can also get clots moving it
from the arm veins and the right atrium
itself but those are usually is so
associated with indwelling lines so the
patient would have had a long term
catheter in for intravenous antibiotics
at half-sister fibrosis for example or
perhaps they've got a pacing wire or
something similar which allows a clot to
form in a place where normally they do
not form there are some rare causes of
pulmonary emboli where the clot may well
wear the material that is embolized to
lung may not actually be clot and these
include amniotic fluid embolism that
occur during delivery of a baby fat
embolism which occurs in patients who've
had long bone fractures after a
motorcycle accident for example tumor
embolism is occasionally occurs where a
tumor may actually cause lumps of cancer
to fall off into the circulation and fly
round to the lungs and the same thing
can happen within affected clots which
is most often occurs in patients who had
intravenous drug abuse when they have
right-side endocarditis and small bits
of an infected material can fall off the
infected valve and go into the lung to
cause clots and abscesses is there and
then sickle-cell disease is often
associated with bhumi emboli or or the
disease that's similar to from remember
like deep vein thrombosis is impermeable
I have the same risk factors because
deep vein burn from deep vein thrombus
or from remember live most of the time
and these risk factors can be divided
into free
in categories one is the increased
coagulation of the blood and the
commerce cause that would be pregnancy
the old concept of pill or other
hormonal therapy and malignancy but also
occurs when patients have congestive
cardiac failure if they have an
increased platelet count due to problems
with Maya privation disorders of their
of their marrow in patients with chronic
information and also in smoking and the
field wall damage will make a clot more
likely to occur and this is most obvious
in patients who have had pelvic surgery
or some description i've Garnica logical
or orthopedic surgery in which case they
have a very high risk of early a DVT and
then potentially a PE after that and
then either blood flow is reduced
because of immobility surgery pregnancy
etc that also make a clot more likely to
form and so from this you can identify
the patients were most risk of DVT s and
therefore PE those are patients with
malignancy recent surgery especially
pelvic orthopedic those who are pregnant
those have been a mobile due to a long
flight or a long car journey etc emboli
to the lungs will vary in their clinical
presentation depending on the size of
the embolus and we can divide this into
three main categories and the acute
presentation this might be a
medium-sized clot and this will fly off
into the pool recirculation but not
lodge at the beginning of the pulmonary
artery but deeper down in one of the
medium for Mary arteries and cause
infarction or tissue distal to that and
these patients present with a short
history largely of cough breathlessness
hemoptysis a large clot large enough to
block a pulmonary artery will have a
very sudden history and the main problem
these patients will present with is the
cardiovascular disturbance from blocking
the pulmonary artery the whole of the
body's circulation goes through the
pulmonary arteries and therefore if you
make a significant obstruction to that
and that's going to have very marked
effects on your blood pressure and your
cardiovascular function the last
presentation is much more chronic and
those are multiple small clots and these
patients have a long history
which may be a very devoted over weeks
or months and this is due to small
emboli clocking off individually a small
artery but which in itself probably has
little effect but when you have multiple
art emboli clogging off multiple
arteries then that eventually will lead
to breathlessness problems with gas
exchange and the patient will present
with breathlessness and potentially the
consequence of pulmonary hypertension
developing due to loss of the arterial
circulation due to multiple small plants
so the Q presentation any age either sex
equally there's usually an obvious
pre-existing risk factor recent surgery
have just flown back from Australia is
on the oral contraceptive pill for
example the type presentation will the
very large clots that may be cardiac
arrest the patient may just drop dead
essentially a sudden onset clot not
quite enough to stop the heart will
cause hypertension cardiovascular shock
significant respiratory distress
the smaller clots in the medium-sized
one
they will cause infarction of the lung
and that causes paretic information and
therefore pleurisy and pleuritic chest
pain him opt assists and breathlessness
those are the classical presentations
are somebody with acute P's with the QP
the general signs will show that there
has been some form of physiological
disturbance there'll be tachycardia
there may be a third heart sound raised
jvp showing that there's some sort of
right heart strain and of course there
might be evidence of the pre-existing
DVT although in many patients that is
not clinically apparent and then there
are the respiratory symptoms and signs
they have a raise which rate there may
be a pleural rub over the affected area
where the infarction has occurred and
there might be a signs of a small
effusion which is often associated with
that pleura information
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