Pulmonary embolism: recognition and priorities
The classic picture is sudden dyspnea with pleuritic chest pain, tachycardia and a falling saturation, in someone who has a reason to have clotted. In practice the presentation is often quieter: unexplained tachycardia, anxiety, a saturation that has drifted down, or a syncope. Ask what created the risk: recent surgery, immobility, a long journey, a cast, cancer, pregnancy or the postpartum period, combined hormonal contraception, a previous event. A calf that is swollen, warm and tender on one side supports it. Suspect it in particular when the respiratory examination does not explain the hypoxemia. Clear lungs with a dyspneic, tachycardic, hypoxemic client is the combination that should raise it. Immediate priorities: sit the client up, give oxygen, take a full set of vital signs including the respiratory rate, obtain an electrocardiogram, establish venous access and notify without delay. Do not send the client walking to a test. The respiratory rate is the sign that is most often not counted and the one that most often changes first. Count it for a full minute. Red flags for a massive embolism: hypotension, altered level of consciousness, a client who cannot complete a sentence.