References
Continuing Professional Development: Pulmonary embolism in pre-hospital care
Abstract
Overview
Pulmonary embolism (PE) is a potentially life-threatening disease, which presents with non-specific signs and symptoms. Evidence suggests that diagnosis is often made on post-mortem examination and misdiagnosis is likely. There are a number of pathophysiological processes that occur in acute PE, which have several systemic effects on the body and the compensatory mechanisms. A thorough understanding of these physiological processes and how these manifest, will afford the attending clinician a greater knowledge base on which to develop clinical reasoning skills, therefore initiating timely management and transportation to definitive care. Clinicians should also have an awareness of adjunctive therapies available in the management of PE, which include inotropic support for profound shock and thrombolytic therapy in cardiac arrest. This article explores the pathophysiology of the disease process, the identification and pre-hospital management of PE.
After completing this module, the paramedic will be able to:
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You are called to a 65-year-old female, who has a painful leg. Upon arrival, you are greeted by the patient's husband who takes you inside the house. The patient is sat up in bed and reports waking up this morning with acute lower left leg pain, about which she had become increasingly concerned prior to a GP appointment later that afternoon. The patient also complains of some shortness of breath on exertion. Upon clinical assessment you observe the following:
From the clinical assessment, you suspect that the patient has a potential pulmonary embolism (PE). Treatment is initiated with high-flow oxygen therapy, intravenous cannulation and rapid transportation to the nearest emergency department. En route, the patient appears to deteriorate and you believe that cardiac arrest is likely. You inform the hospital staff, who have a team waiting for your arrival.
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