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A pulmonary embolism (P.E) is a condition where a pulmonary vessel in the either or both lungs becomes blocked. The blockage is usually caused by one or more blood clots which have travelled through the venous system from another part of the body.

Commonly pulmonary embolisms are caused by a clot being transferred from smaller vessels in the leg, arm or heart (Fell, 2005). The blood clot travels around the venous system until it reaches a point where it can no longer travel freely. As a result of this, blood flow is reduced to the affected area of the lung.

Symptoms of a pulmonary embolism

Shortness of breath – the patient may struggle to complete a sentence.

Perspiration – the patient may be sweaty and clammy

Change in pallor – in severe cases of pulmonary embolism the patient may look pale and ashen.

If the blood clot is large, or the patient has not received medical assistance in adequate time, a pulmonary embolism can result in a cardiac arrest.

The following are the common presenting symptoms of a pulmonary embolism:

Diagnostic Tests

Electrocardiogram

(ECG) – ECG changes can be present in a patient presenting with a pulmonary embolism. Pulmonary embolism should not be ruled out in cases where there are no significant ECG changes. Inverted anterior T-waves on an ECG can be indicative of a P.E however this is usually in the case of a 'massive' embolism.

Erect chest x-ray

- In most cases of a suspected P.E a physician will request a chest x-ray. This test is unlikely to display any abnormality which will assist the diagnosis of a P.E however it can highlight other potential conditions which may be causing the symptoms.

Arterial Blood Gases –

This test involves the physician taking a small sample of blood from the radial artery. If the patient is cyanosed or hemodynamically unstable then a sample may need to be taken from the femoral artery. The blood sample is analyzed within minutes, on a machine usually available in the E.R. Arterial blood gases may be helpful in the overall assessment and management decisions of a dyspneic patient, but will not help rule in or out a P.E (Stein, 1996).

C.T Scan –

This involves a contrast dye being injected into a venous cannula, images are then taken to observe the flow of the dye through the venous system and into the pulmonary vessels. If there are any areas blocked or poorly perfused then a C.T scan will indicate this.

Pulmonary Angiography –

This test requires the insertion of a catheter into a large vein located in the groin (inferior vena cava). Contrast dye is then injected into the catheter and images of the dye are then observed to identify its course and

Because the symptoms of a pulmonary embolism can mimic other medical conditions (such as acute myocardial infarction), specific diagnostic tests are required to give a definitive diagnosis. The following tests are carried out when the patient is taken into medical care:determine any poor filling or blocked areas. Pulmonary angiography is the accepted «gold standard» test, but it is invasive and difficult to interpret, and can give false-negative results (Walling, 2003).

Chest pain – often exacerbated by taking a deep breath.

The only definitive treatment for preeclampsia is delivery of the unborn child and placenta. This intervention, even in the case of premature delivery, is the safest option for both mother and child.

In cases where preeclampsia symptoms appear mild (traces of protein in the urine, with minimal elevation of the blood pressure), anti-hypertensive therapy is recommended to regain control of the blood pressure. In some cases this treatment is sufficient to allow a pregnant woman to progress to a more viable stage of pregnancy for delivery in the event that the preeclampsia worsens.

In the event that blood pressure begins to rise despite the administration of anti-hypertensive medication, intravenous anti-hypertensives are the next treatment choice. Hydralazine is the drug of choice in most cases. Ace-inhibitors are advised against as research indicates a risk of fetal harm. Treatment is then titrated to the blood pressure, which itself will need to be monitored frequently. Anticonvulsant medication such as that of intravenous Magnesium Sulphate, is usually introduced at this stage, as a prophylactic measure, its function is to reduce vascular spasm. The drug is not recommended for use unless it is clear that the preeclamsia is progressing toward a situation where the mother and baby are at immediate risk (Warden, 2005).

Despite advances in so many areas of medicine, prevention of preeclampsia has still not been fully established. The introduction of prophylactic dose Aspirin, 75mgs daily, is a treatment exercised by some (not all) obstetricians and general practitioners, when a woman is identified as being in one or more of the risk groups. The benefits of Aspirin are believed to result in less placental aggregation and therefore less placental ischaemia which is the reason why the baby is at risk of death (Redman et al, 1978).

When a woman with a history of preeclampsia presents with any subsequent pregnancy, it is common practice that she be offered more frequent maternal monitoring, by means of blood pressure and urine checks, as well as the likelihood that she may have a planned (booked) induced labor or cesarean section earlier than 40 weeks in the event that preeclampsia develops once again. Booked procedures are usually performed at around 37 or 38 weeks gestation.

http://www.vitalethics.org/classes.html

The only definitive treatment for preeclampsia is delivery of the unborn child and placenta. This intervention, even in the case of premature delivery, is the safest option for both mother and child.

In cases where preeclampsia symptoms appear mild (traces of protein in the urine, with minimal elevation of the blood pressure), anti-hypertensive therapy is recommended to regain control of the blood pressure. In some cases this treatment is sufficient to allow a pregnant woman to progress to a more viable stage of pregnancy for delivery in the event that the preeclampsia worsens.

In the event that blood pressure begins to rise despite the administration of anti-hypertensive medication, intravenous anti-hypertensives are the next treatment choice. Hydralazine is the drug of choice in most cases. Ace-inhibitors are advised against as research indicates a risk of fetal harm. Treatment is then titrated to the blood pressure, which itself will need to be monitored frequently. Anticonvulsant medication such as that of intravenous Magnesium Sulphate, is usually introduced at this stage, as a prophylactic measure, its function is to reduce vascular spasm. The drug is not recommended for use unless it is clear that the preeclamsia is progressing toward a situation where the mother and baby are at immediate risk (Warden, 2005).

Despite advances in so many areas of medicine, prevention of preeclampsia has still not been fully established. The introduction of prophylactic dose Aspirin, 75mgs daily, is a treatment exercised by some (not all) obstetricians and general practitioners, when a woman is identified as being in one or more of the risk groups. The benefits of Aspirin are believed to result in less placental aggregation and therefore less placental ischaemia which is the reason why the baby is at risk of death (Redman et al, 1978).

When a woman with a history of preeclampsia presents with any subsequent pregnancy, it is common practice that she be offered more frequent maternal monitoring, by means of blood pressure and urine checks, as well as the likelihood that she may have a planned (booked) induced labor or cesarean section earlier than 40 weeks in the event that preeclampsia develops once again. Booked procedures are usually performed at around 37 or 38 weeks gestation.

http://www.vitalethics.org/classes.html

Because one of the primary symptoms of preeclampsia is high blood pressure, this in turn makes the pregnant woman at an increased risk of stroke or altered kidney and/or liver function, blood clotting abnormalities, seizures and pulmonary edema as a result of excessive fluid build up in severe cases. In serious cases of preeclampsia which may be subject to delayed or inappropriate treatment, both the mother and the unborn child are at risk of death.

Preeclampsia directly affects the blood supply to the fetus, therefore the condition often produces low birth weight, or in many cases premature babies due to a need to deliver the baby early, to avoid further complications. The problems associated with premature birth are well documented, therefore early treatment of preeclampsia is favorable in an attempt to reduce symptoms and risks, and allow the pregnancy to continue for as long as is possible, without putting the mother or her unborn child at risk.

When hospitalization is necessary due to the onset of preeclampsia, a woman will normally be advised to maintain bed-rest. Frequent fetal monitoring will be conducted to ensure the baby is progressing well and in no apparent distress. The pregnant woman will be required to provide a urine sample daily, to test for protein, and blood pressure is checked 4-6 hourly in the 'stable' patient. All of these tests are repeated more frequently if it appears that the preeclampsia is escalating.

It is a misconception that preeclampsia always resolves immediately that the baby and placenta have been delivered. A woman can remain at very high risk up to 48 hours after delivery, therefore monitoring is essential in the post-natal period. Preeclampsia can occur up to 2 weeks after the delivery. In some cases the preeclampsia can become significantly worse in the immediate post-natal phase, in such cases women require 'high dependency' post natal care.

Michael Morales

http://www.vitalethics.org/pals.html

Because one of the primary symptoms of preeclampsia is high blood pressure, this in turn makes the pregnant woman at an increased risk of stroke or altered kidney and/or liver function, blood clotting abnormalities, seizures and pulmonary edema as a result of excessive fluid build up in severe cases. In serious cases of preeclampsia which may be subject to delayed or inappropriate treatment, both the mother and the unborn child are at risk of death.

Preeclampsia directly affects the blood supply to the fetus, therefore the condition often produces low birth weight, or in many cases premature babies due to a need to deliver the baby early, to avoid further complications. The problems associated with premature birth are well documented, therefore early treatment of preeclampsia is favorable in an attempt to reduce symptoms and risks, and allow the pregnancy to continue for as long as is possible, without putting the mother or her unborn child at risk.

When hospitalization is necessary due to the onset of preeclampsia, a woman will normally be advised to maintain bed-rest. Frequent fetal monitoring will be conducted to ensure the baby is progressing well and in no apparent distress. The pregnant woman will be required to provide a urine sample daily, to test for protein, and blood pressure is checked 4-6 hourly in the 'stable' patient. All of these tests are repeated more frequently if it appears that the preeclampsia is escalating.

It is a misconception that preeclampsia always resolves immediately that the baby and placenta have been delivered. A woman can remain at very high risk up to 48 hours after delivery, therefore monitoring is essential in the post-natal period. Preeclampsia can occur up to 2 weeks after the delivery. In some cases the preeclampsia can become significantly worse in the immediate post-natal phase, in such cases women require 'high dependency' post natal care.

Michael Morales

http://www.vitalethics.org/pals.html

http://www.vitalethics.org

http://www.vitalethics.org

By Randolph Gordon Medical experts, Holistic practitioners, Naturopaths and Herbalists all agree that one of the best ways to lose weight is to consume fewer calories and increase your physical activity. Experts also suggest aiming for a realistic weight loss goal of about a pound a week. Depending on your weight loss program, losing more than a pound per week is absolutely possible. quick weight loss diets can be used to jump-start the weight loss process.

Depending on your metabolism, sometimes losing weight can be a challenging proposition. The weight gain/weight loss equation can sometimes be very tricky and complex. While it is true that people gain weight because of excessive calorie intake, there is another little known culprit that gets far less attention. Sometimes the reason you can’t loose weight has nothing to do with the amount of exercise you do or your will power.

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Decreased level of consciousness or “DLOC” is one of the most common calls to EMS. DLOC can be caused by many things and for different reasons. What often is called “unresponsive” is actually DLOC. Victims with a decreased level of consciousness are not entirely unresponsive, but often their level of consciousness is decreased to the point that it appears so to the untrained eye. Often CPR has been started on victims with DLOC. This is not the appropriate course of action. If a person is breathing, that means that they have a working heart. This is true even if their level of consciousness is decreased. If the heart is working then CPR is contraindicated.

Often patients with a decreased level of consciousness are in serious trouble. They may respond inappropriately to verbal commands or may only respond to physical stimuli. Many times bystanders have no idea what is wrong, and at other times a bit of medical history can provide some valuable clues and shed some light on the situation. Care for the victim with a decreased level of consciousness includes management of the airway and breathing. Generally, the recovery position is the best position for the person as long there is no indication of head, neck or back injury. However, if the victim is in a comfortable position on something like a sofa chair or in any position where there is no risk of them falling, then that would be acceptable. As long as the victim is breathing they are alive, and CPR must not be performed on someone who is breathing.

Quite often the problem can be related to blood sugar levels, electrolyte imbalance or other type of blood chemistry disorder. It may also be a stroke, medication over dose or serious infection. Sometimes it can be difficult for EMS providers to determine what exactly is wrong, and in many cases the answer may only be proved after extensive hospital assessment. In any case, decreased level of consciousness is a true medical emergency and should prompt bystanders to call 911 or the local emergency number in addition to providing appropriate basic life support care.

Michael Morales EMT-Paramedic

http://www.vitalethics.org