Presentation

Patients presenting with dyspnea, chest pain, and/or hemoptysis in the presence of venous thrombosis should be evaluated for pulmonary embolus, although only a quarter will have all three symptoms. In a national co-operative study ( Urokinas^ 1973), dyspnea was found to occur in 81 per cent of patients, with chest pain in 72 per cent, cough in 53 per cent, and hemoptysis in 34 per cent. Associated findings of tachypnea (88 per cent) and tachycardia (30 per cent) were also noted, and additional symptoms, such as apprehension, can present in up to half of these patients ( Table 1). In mechanically ventilated patients, an acute fall in oxygen saturation, elevation in mean pulmonary artery and right atrial pressures, or onset of otherwise unexplainable cardiovascular collapse should raise suspicions of pulmonary embolism (Tib.!§ 2). Approximately one-third of patients with pulmonary embolism will also present with findings consistent with lower-extremity venous thrombosis. Other common physical findings include rales, accentuated P2, fever, S1 or S2 gallop, diaphoresis, cyanosis, and hypotension. Because of the non-specific nature of the signs and symptoms of pulmonary embolus, the differential diagnosis must also include myocardial infarction, pneumonia, pneumothorax, and atelectasis.

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Table 1 Pulmonary embolism in spontaneously breathing patients

Table 1 Pulmonary embolism in spontaneously breathing patients flaiï teifwifl r prflsraKr rçpucapnû. m Kntei MM rip mmea; pdnaiirçil&ï Hnriwtt

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Table 2 Pulmonary embolism in mechanically ventilated patients

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