A pulmonary embolism is often caused by the formation of a deep vein thrombosis (DVT) which then breaks free and travels to the lung, causing a blockage within the pulmonary artery. Depending on the size of the thrombus, and the location within the pulmonary arterial tree, this blockage will result in a minor decrease in oxygenation of the blood through to a complete obstruction resulting in sudden death.
As a paramedic, it is vital to maintain a high index of suspicion in any patient who presents with chest pain or shortness of breath. It is not uncommon to treat a patient who appears to have a minor respiratory problem, who on further investigations is determined to have a pulmonary embolism. Not all pulmonary embolisms are fatal, but they should all be treated with urgency.
The following are signs of a pulmonary embolism that paramedics should be aware of:
1. Sudden increase in shortness of breath.
2. Chest pain, particularly pin pointed chest pain. Cardiac chest pain is often difficult for a patient to describe. They will often complain of a heaviness or a funny feeling over the entire chest, where as a person who has a pulmonary embolism will normally describe a sharp pain at the point of the blockage. This makes it particularly difficult for the assessing paramedic, because it is often initially identified as pleuretic pain.
3. Pain or swelling to the calf muscle.
4. Increase respiratory rate without clear clinical causes, such as asthma, COPD, CCF. Be cautious with the patient who appears to be simply hyperventilating, but denies any recent cause of anxiety in an otherwise healthy person.
5. Severely decreased oxygen saturations in a person who has clear breath sounds.
6. Tachycardia, as a means of compensation.
7. S3 and S4 gallop.
10. Lower extremity oedema.
Associated conditions that may be the result of a pulmonary embolism or a sign of a pulmonary embolism. These can be applied to a variety of our otherwise well patients!
2. Fever – surprising a lot of patients with a pulmonary embolism have a increased body temperature.
3. Abdominal pain.
4. Flank pain.
5. New onset of atrial fibrillation.
Remember, unless you look for it, you will miss it!