a 30 yr old paraplegic male has a long history of UTI secondary to an indwelling foley catheter.he develops fever and hypotension requiring hospitalization, fluid therapy and intravenous antibiotics.he improves but over 1 week becomes increasingly shoness of breath and tachypneic.he develops frothy sputum ,diffuse alveolar infiltrates there is no fever jugular venous destention ,s3 gallop or peripheral or sacral edema.the best prognosis is ?
DEFINITION * Pulmonary embolism is the blockage of 1 pulmonary aeries by thrombus,fat or air emboli and tumour tissue. * It is the most common complication in hospitalised patients. * An embolus is a clot or plug that is carried by the bloodstream from its point of origin to a smaller blood vessel, where it obstructs circulation. ETIOLOGY AND RISK FACTORS * Viually all pulmonary embolisms develop from thrombi(clots),most of which originate in the deep calf,femoral,popliteal,or iliac veins. * Other sources of emboli include tumours, fat, air, bone marrow, amniotic fluid, septic thrombi, and vegetations on hea valves that develop with endocarditis. * Major operations ,especially hip, knee, abdominal and extensive pelvic procedures predispose the client to thrombus formation because of reduced flow of blood through pelvis. * Travelling in cramped quaers for a long time or sitting for long periods is also associated with stasis and clotting of blood. The best treatment for a pulmonary embolus is prevention. Minimizing the risk of deep vein thrombosis is key in preventing a potentially fatal illness. The initial decision is whether the patient requires hospitalization. Recent studies suggest that those patients with a small pulmonary embolus, who are hemodynamically stable (normal vital signs) may be treated at home with close outpatient care. ref : harrisons 21st ed
blood cultures
CT SCAN of the chest
pulmonary capillary wedge pressure
ventilation perfusion scan
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