Pulmonary Embolism: NCLEX Priorities
PE: Virchow's triad, sudden dyspnea, anticoagulation, thrombolytics for massive PE.
Pulmonary embolism is sudden, often fatal. NCLEX tests recognition, D-dimer, anticoagulation.
Risk factors (Virchow's)
Stasis (immobility, surgery, long flights). Hypercoagulability (OCPs, pregnancy, cancer, factor V Leiden). Endothelial injury (trauma, surgery).
Recognition
Sudden dyspnea, pleuritic chest pain, tachycardia, tachypnea. Hypoxemia. Hemoptysis (less common). Hypotension in massive PE.
Diagnostics
D-dimer (sensitive, not specific). CT pulmonary angiography gold standard. V/Q scan if contrast contraindicated.
Treatment
Anticoagulation (heparin → warfarin or DOAC). Thrombolytics (tPA) for massive PE with hemodynamic instability. Embolectomy if thrombolytics contraindicated. IVC filter if anticoagulation contraindicated.
Frequently asked
Wells score?
Clinical prediction rule. Low probability + negative D-dimer rules out PE.
DVT prophylaxis post-op?
Mechanical (SCDs) + LMWH or heparin. Reduce stasis.
Quick check
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