Pulmonary embolism should be treated in the department of respiratory medicine.

Written by Wang Li Bing
Intensive Care Medicine Department
Updated on September 03, 2024
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Pulmonary embolism is an emergency in clinical settings, with rapid progression and extreme danger, and is generally treated by the department of respiratory medicine. Pulmonary embolism primarily occurs due to dislodged blood clots that block the pulmonary artery and its branches, leading to pulmonary infarction. The clinical manifestations of pulmonary embolism mainly include severe breathing difficulties, chest pain, coughing up blood, and even circulatory disturbances. After a pulmonary embolism occurs, a pulmonary artery CT scan can be used to further confirm the diagnosis. Treatment options may include thrombolysis, and possibly anticoagulation therapy with low molecular weight heparin or warfarin. (Specific medications should be used under the guidance of a physician.)

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Written by Yuan Qing
Pulmonology
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Can acute pulmonary embolism be cured by anticoagulation?

Anticoagulation has a partial curative effect on acute pulmonary embolism. Based on the area of the embolism and the patient's vital signs, it is classified into mild, moderate, and severe pulmonary embolism. If it is a mild to moderate pulmonary embolism, anticoagulation can completely cure it, because anticoagulation can help the body's fibrinolytic system remove the blood clots that have already formed, and it can also prevent new clots from forming. However, in cases of severe pulmonary embolism, especially when the patient presents unstable vital signs and is in life-threatening condition, it is not advisable to rely solely on anticoagulant therapy. This is because the effect of anticoagulant treatment is relatively slow, and it requires a certain amount of time for the body's immune and fibrinolytic systems to clear the embolism. Therefore, at such times, thrombolytic treatment is recommended. Of course, this requires an experienced physician to assess the patient's vital signs and overall condition.

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Written by Wang Li Bing
Intensive Care Medicine Department
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The most common symptoms of pulmonary embolism.

Pulmonary embolism is also relatively common in clinical practice, primarily caused by an embolus blocking the pulmonary artery system, leading to a group of clinical syndromes. The clinical manifestations of pulmonary embolism mainly include the following points: The first is that patients may experience unexplained difficulty breathing and shortness of breath, especially after activity. The second is that patients experience significant chest pain. The third may be accompanied by hemoptysis, but usually, the amount of blood expectorated is not large. The fourth is that patients may experience restlessness, panic, and even a sense of impending doom. Clinically, there sometimes appears the so-called triad, which includes simultaneous occurrence of difficulty breathing, chest pain, and hemoptysis, etc. Pulmonary embolism is primarily diagnosed clinically through pulmonary artery CT.

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Written by Yuan Qing
Pulmonology
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Why do patients with pulmonary embolism feel sleepy?

Patients with pulmonary embolism primarily suffer from emboli within the venous system, which travel back to the right heart and then become lodged in the pulmonary artery, forming a pulmonary artery thrombus. This reduces pulmonary blood flow and impacts the exchange of air in the lungs, leading to hypoxia in the patient. Following hypoxia, the brain tends to enter a sleepy state, thus many patients with pulmonary embolism exhibit sleepiness. This sleepiness is related to the pathophysiological mechanisms of pulmonary embolism. At this point, it is crucial to provide sufficient oxygen to the patient to address their hypoxemia. Ultimately, the most fundamental treatments are prompt thrombolysis or anticoagulation therapy to resolve the embolus, addressing the condition fundamentally.

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Written by Yuan Qing
Pulmonology
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Can a secondary recurrence of pulmonary embolism be treated?

Pulmonary embolism, even if it recurs for the second time, is treatable, but the approach should differ from the first recurrence. It's vital to determine the cause of the pulmonary embolism, although many patients with this condition do not have an identifiable cause. For such patients, long-term oral anticoagulants might be recommended. With long-term use of oral anticoagulants, the likelihood of thrombosis, especially in the venous system, significantly reduces. This means that the chance of recurrence in patients also decreases considerably. However, if the cause can be identified, it is better to address and eliminate it. For instance, if the cause is long-term use of oral contraceptives or the presence of varicose veins, these primary or secondary factors should be resolved. The treatment should not just focus on anticoagulation or thrombolytic therapy, as there could still be a possibility of a future pulmonary embolism recurrence.

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Written by Wei Shi Liang
Intensive Care Unit
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How long does the treatment for pulmonary embolism take?

The timing of pulmonary embolism treatment mainly depends on the severity of the pulmonary embolism. The main goals of pulmonary embolism treatment are to save lives by addressing life-threatening right heart dysfunction and obstructive shock caused by the pulmonary embolism, to re-establish pulmonary vascular patency, restore lung tissue perfusion, and prevent the recurrence of pulmonary embolism. Main treatment methods include: respiratory and circulatory support, anticoagulation, thrombolysis, interventional or surgical removal of blood clots, placement of inferior vena cava filters, etc. General management: Patients who are highly suspected or diagnosed with pulmonary embolism should be closely monitored, tracking changes in respiration, heart rate, blood pressure, venous pressure, electrocardiogram, and blood gases to prevent the dislodgement of clots again. Absolute bed rest is required, and care should be taken not to overly bend the lower limbs, maintain bowel regularity, and avoid straining. For patients experiencing anxiety and panic symptoms, reassurance should be provided, along with appropriate use of sedatives. If there is chest pain, analgesics may be administered. For symptoms like fever and cough, corresponding symptomatic treatments should be given. To prevent lung infections and treat phlebitis, antibiotics may be used. Additionally, support treatments for respiratory and circulatory functions, as well as anticoagulation therapy, should be provided.