Pulmonary Embolus

Pulmonary embolism may present any time during the postoperative period. A lower-extremity or pelvic thrombus dislodges and migrates to the pulmonary vasculature. The presenting signs and symptoms vary, depending on the size of embolus and the underlying cardiopulmonary status of the patient. Patients have varying degrees of dyspnea, chest pain, cough, and anxiety. Hemoptysis is usually seen only late in a patient's course and with massive pulmonary embolism. The patient may have essentially normal vital signs or be tachypneic and tachycardiac.

Diagnosis of pulmonary embolism is difficult because of the poor sensitivity of noninvasive tests. While hypoxemia and a widened alveolar-arterial (A-a) oxygen gradient are frequently found with larger emboli, patients may have normal oxygen content and a normal A-a gradient. Diagnosis requires venous Doppler ultrasonography, ventilation-perfusion scan, pulmonary computed tomography (CT) scan, or pulmonary angiography. Patients with low clinical suspicion, normal vital signs, good oxygenation, and a low probability scan can be discharged, provided other causes of their symptoms have been addressed.

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