1. Pulmonary Embolism

2. Introduction  Pulmonary Embolism is a complication of underlying venous thrombosis, most commonly of lower extremities and rarely from pelvic, upper extremity veins or right heart chambers. Clinical Presentation : symptoms vary from sudden catastrophic hemodynamic collapse to gradually progressive dyspnoea Classically present with abrupt onset of pleuritic chestpain,SOB and hypoxia. Most patients have no obvious symptoms at presentation.

3.  Physical Signs : Tachypnea - 96% Rales - 58% Tachycardia - 44% Fever - 43% Diaphoresis - 36% Lower extremity edema - 24% Cardiac murmurs - 13% Cyanosis - 19%

4. Diagnosis  Lab Tests : D Dimers WBC ABGs Imaging studies : CTPA – Gold standard investigation Pulmonary Angiography – when CTPA not available especially CXR V/Q Scan – when CTPA contraindicated ECG MRI – Emboli show incrased signal density within pumonary artery. Venography and Duplex U/S : to demonstrate DVT

5. Management  Thrombolytic therapy : for Massive PE  Anticoagulation : immediate anticoagulation is mandatory for all suspected cases of PE or DVT and diagnostic testing should not delay anticoagulation Long term anticoagulation to prevent recurrence of PE or DVT. Anticoagulants include heparin,LMWH,fodaparinux,Factor Xa Inhibitors and Warfarin. Surgical Treatment : catheter embolectomy and fragmentation placement of IVC filters