He came in on room air – somewhat dyspneic with a respiratory rate of 28 and shallow breathing. His O2 saturation was 95%. He was a young guy, 32 years old, with no prior medical or surgical history. After settling him into his ICU room, I headed out to the nurses’ station to write my admission assessment. The physicians were at the bedside completing their physical examinations. Suddenly, alarms started ringing like crazy. I ran into the room and immediately started to bag this patient with 100% oxygen. A flurry of activity began --- intubation, heparin bolus and I.V. infusion begun --- before I knew it, someone had started CPR. Wow – what was going on? How had he decompensated so quickly?

I was reminded of this patient when I read Acute Pulmonary Embolism in the April/June issue of Critical Care Nursing Quarterly. Pulmonary embolism (PE) has always been one of the scariest diagnoses to me. When a patient came in with a ‘rule out PE’ diagnosis, I was nervous; a ‘road trip’ to Nuclear Medicine made me really nervous!

Fortunately, admissions similar to this were not a regular occurrence. You can imagine that the sudden death of a young patient had a great impact on me and the rest of the team that day. I was a pretty new nurse and the details of the events have faded a bit from my memory. What I do remember clearly is that one minute I was speaking with this new admission and within moments (or so it seemed) he was coding. 

PE occurs when the pulmonary artery or one of its branches is occluded by a thrombus that originates somewhere in the venous system or the right side of the heart. The thrombus essentially breaks free from where it formed and travels to the lungs. In the lungs, it blocks vessels and causes impaired gas exchange, which leads to hypoxia. Symptoms of PE are commonly nonspecific – tachypnea, crackles, tachycardia, cough, chest pain, dizziness, anxiety, and dyspnea. Patients may also present with frothy, pink sputum or hemoptysis. 

I’ve listed several resources below if you’d like to read more about PE. You can also search ‘pulmonary embolism’ on NursingCenter to see all of our journal content on this subject. 

Resources:

Gay, S. (2010). An Inside View of Venous Thromboembolism. The Nurse Practitioner: The American Journal of Primary Health Care, 35(9). 

McLenon, M. (2012). Acute Pulmonary Embolism. Critical Care Nursing Quarterly, 35(2). 

Moz, T. (2008). Pulmonary Embolism: More Than Just Short of Breath. LPN2008, 4(6).