Pulmonary Embolism: Risk Factors

by Carlo Raj, MD

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    00:00 Alright, what else? Past history of PE is important in terms of risk factors.

    00:04 Age, hypercoagulable states. What are these? Cancers. What else? What is the most common hypercoagulable familial disease? Good. Factor V Leiden.

    00:18 That you must know. And so therefore that your glutamic acid to arginine type of substitution and position 506.

    00:27 How do I know that? That's my phone number. No, I'm joking.

    00:29 It is position 506 but your glutamate, which is then being replaced by arginine.

    00:34 Keep that in mind please, extremely important. The most common hereditary hypercoagulable.

    00:40 I didn't say secondary, hereditary, can't help it. Okay.

    00:44 Oral contraceptive use, if it contains, what? Estrogen. That's huge, isn't it? Say that in Miami, you have a 16-year-old girl. They're - whatever - what are they doing? They're going out partying unbeknownst to the 16-year-old girl who gets into a club.

    00:57 Trust me, everyone gets into a club in Miami.

    00:59 And now this girl obviously is dancing and she falls dead. Wow.

    01:04 She was taking oral contraceptive pill. Happens all the time.

    01:07 Not all the time, but it happens more often than we would like.

    01:10 And she doesn't know what kind of effect estrogen has on her body, it’s pro-thrombotic, isn't it? Yeah, it is.

    01:16 Aren't you worried about a pregnant lady as well? Sure you are.

    01:20 And what about a pregnant lady also developing DVT because of increased estrogen? Welcome to oral contraceptive use, estrogen, that's why you mix it. You mix it.

    01:28 What other some - are there some other risk factors? Immobility, I just told you about the hospitalized patient postoperatively, trauma, travel.

    01:35 Now, this is quite common and things that you wanna keep in mind because see, the people that are traveling don't know that this is occurring, that's the issue.

    01:46 Whereas if you're in a hospital setting, well, you know -- doctors, residents, you, no.

    01:51 Wow, there's a possibility of developing DVT.

    01:53 But if you're a businessman or businesswoman, you're traveling quite a bit and especially transatlantic, transpacific, you're spending a lot of time on your butt, on a seat.

    02:02 And when you do so, guess what? Yeah. Absolutely at risk for developing DVT and may then result in a PE. What about a fat emboli? What might you be thinking about here? It's the long bone in which when you're fractured, think.

    02:18 Long bone, cortical bone, solid on the outside. What's in the middle? Lots of space.

    02:25 It's called a bone marrow. That bone marrow is filled up of grandit, stem cells.

    02:29 That's not what I'm going for.

    02:30 You have your lipid, so therefore, if you have a long bone fractured and even liposuction to a certain extent.

    02:37 So doing the procedure of liposuction, there's every possibility that you might then introduce fat emboli into the blood, may result in PE. Good.

    02:50 With the classic triad, hypoxemia, neurologic abnormality, pretty nonspecific, but the petechial rash, those three, okay, would be your triad high on your differential, you should be suspecting fat emboli.

    03:03 Let's continue. Who's this patient? Amniotic fluid emboli. Obviously, a pregnant lady.

    03:08 And what happens here? All of a sudden during delivery, unfortunately, it doesn't always have to be, but mostly.

    03:16 There's complications during delivery. You've heard of abruptio placenta.

    03:20 You've also heard of things like accreta.

    03:23 Placenta accreta and these are pretty major issues, only because when you have the maternal-fetal type of mixing and exchange, you might get some of that amniotic fluid, oh my goodness, into the mother's circulation.

    03:39 And then amniotic fluid inside the maternal circulation may then result in amniotic fluid emboli that's going to cause death. Death.

    03:48 Yeah, that's no joke risk factors.

    03:50 Air emboli. And here you're thinking about Caisson disease.

    03:54 And what that means is that, this is a patient, not so much diving in too quickly, it's the fact that you're, take a look, ascending too quickly.

    04:03 When you're ascending too quickly, it's a decompression sickness. This is called Caisson.

    04:08 Maybe some of you have heard of this being bends.

    04:10 And so therefore it, you have nitrogen bubbles and such which then are trapped in your tissue and trapped in your joints and that causes major, major pain.

    04:18 Wait, what's going on here? So all of this could also be part of your process of embolization.

    04:24 Now, iatrogenic etiology from central line, and so what may happen here, the patients treated with hyperbaric oxygen, and so this is something that you wanna keep in mind when a patient is suffering from air emboli, you first hyperbaric oxygen, lot of oxygen.

    04:40 Remember, what does that mean? Normal sea level oxygen is 760.

    04:44 If you do hyperbaric, you're giving them lot of pressure of oxygen in the hopes of delivering this oxygen to where it needs to go.

    04:51 But iatrogenic etiology from placement of central line is a possibility for air emboli as well, keep that in mind.

    About the Lecture

    The lecture Pulmonary Embolism: Risk Factors by Carlo Raj, MD is from the course Disorders of the Pulmonary Circulation and the Respiratory Regulation.

    Included Quiz Questions

    1. Hemophilia
    2. Factor V Leiden disorder
    3. Cancer
    4. Immobility
    5. Pregnancy
    1. Abruptio placentae
    2. Hyperemesis gravidum
    3. HELLP syndrome
    4. Ectopic pregnancy
    5. Gestational diabetes
    1. Pallor
    2. All are part of the classic presentation.
    3. Petechial rash
    4. Neurologic abnormalities
    5. Hypoxemia

    Author of lecture Pulmonary Embolism: Risk Factors

     Carlo Raj, MD

    Carlo Raj, MD

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