Pulmonary embolus - Queensland Ambulance Service

Transcription

Pulmonary embolus - Queensland Ambulance Service
Clinical Practice Guidelines:
Respiratory/Pulmonary embolus
Disclaimer and copyright
©2016 Queensland Government
All rights reserved. Without limiting the reservation of copyright, no person shall reproduce, store in a
retrieval system or transmit in any form, or by any means, part or the whole of the Queensland Ambulance
Service (‘QAS’) Clinical practice manual (‘CPM’) without the priorwritten permission of the Commissioner.
The QAS accepts no responsibility for any modification, redistribution or use of the CPM or any part
thereof. The CPM is expressly intended for use by QAS paramedics whenperforming duties and delivering
ambulance services for, and on behalf of, the QAS.
Under no circumstances will the QAS, its employees or agents, be liable for any loss, injury, claim, liability
or damages of any kind resulting from the unauthorised use of, or reliance upon the CPM or its contents.
While effort has been made to contact all copyright owners this has not always been possible. The QAS
would welcome notification from any copyright holder who has been omitted or incorrectly acknowledged.
All feedback and suggestions are welcome, please forward to:
Clinical.Guidelines@ambulance.qld.gov.au
Date
April, 2016
Purpose
To ensure consistent management of patients with Pulmonary embolus.
Scope
Applies to all QAS clinical staff.
Author
Clinical Quality & Patient Safety Unit, QAS
Review date
April, 2018
URL
https://ambulance.qld.gov.au/clinical.html
This work is licensed under the Creative Commons
Attribution-NonCommercial-NoDerivatives 4.0
International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Pulmonary embolus
April, 2016
Pulmonary embolus (PE) most commonly originates from a deep
venous thrombus (DVT ) of the lower limbs.[1] Clinical presentation
ranges from asymptomatic to sudden death caused by a massive
embolus.[2]
Clinical features (cont.)
UNCONTROLLED WHEN PRINTED
A significant proportion of patients with PE will present with
evidence of DVT, however it should be kept in mind that the
condition can be caused by other emboli, such as fat, air and
amniotic fluid.[3]
Other features:
• Cough
• Haemoptysis
• Low grade fever > 37.5°C
• Signs of DVT
UNCONTROLLED WHEN PRINTED
Cardiac instability is caused by right ventricular failure due to a massive PE with resultant shock.[1] IV fluid boluses should be
administered judiciously (see flowchart), as aggressive fluid
resuscitation may cause further overstretching of an already expanded and failing right ventricle.[4]
- unilateral swelling
- redness; localised warmth
- tenderness
- most often presenting in lower limbs
• Signs of right ventricular dysfunction[6]
UNCONTROLLED WHEN PRINTED
Clinical features
- S1-Q3-T3
- right bundle branch block (RBBB)
The clinical features of PE are varied and non-specific.[5]
Common features:
• Dyspnoea
• Jugular venous distension
• Cyanosis
• Sinus tachycardia
UNCONTROLLED WHEN PRINTED
• Shock or hypotension.
• Tachypnoea
• Pleuritic, or substernal chest pain
• Syncope or near-syncope.
Figure 2.53
QUEENSLAND AMBULANCE SERVICE
166
Risk assessment
CPG: Paramedic Safety
• History of a DVT or PE
CPG: Standard Cares
• Prolonged immobilisation
• Recent surgery, trauma, or hospitalisation
UNCONTROLLED WHEN PRINTED
• Oral contraceptive use
• Hormone replacement therapy
• Cancer
Consider:
Is the patient presenting with cardiovascular instability?
• Pregnancy (the risk is higher during the postpartum period, particularly after a caesarean section).
N
• Oxygen
• Differential diagnosis
• Analgesia
Y
UNCONTROLLED WHEN PRINTED
• Anticipate further deterioration and commence
resuscitation as required
• Oxygen
UNCONTROLLED WHEN PRINTED
• 12-Lead ECG
Differential diagnoses for a PE include:
• AMI
• Pneumonia
• Pericarditis
Consider:
• Differential diagnosis
• IV fluid (adult: 250–500 mL, child: 10 mL/kg )
Transport to hospital
Pre-notify as appropriate
• Adrenaline (epinephrine)
UNCONTROLLED WHEN PRINTED
• CHF
• Pleurisy
• Pneumothorax
• Pericardial tamponade
Note: Officers are only to perform procedures for which they have received specific training and authorisation by the QAS.
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167

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