Introduction
An embolism is a partial or complete obstruction of an artery. A blood clot or an oxygen molecule may block any artery. A pulmonary embolism occurs when a particular pulmonary artery in the lungs gets blocked. It is often caused due to blood clots that move towards the lungs through major arteries inside the legs and, in scarce circumstances, by veins in any other body parts. Since the clots prevent blood from flowing to the lungs, PE may be fatal. For example, a study indicates that PE is recently the third leading cause of cardiovascular mortality. Its clinical manifestations in critically ill patients can go undiagnosed or manifest as abrupt respiratory failure, resulting in death.
Additionally, it is the primary cause of ICU admissions and is linked with a high morbidity and death rate. Identifying and managing PE is a difficult task for physicians. However, it has been shown that quick treatment and care for individuals with PE significantly lowers the chance of mortality. This paper focuses on the treatment and care for patients with pulmonary Embolism for more significant health outcomes by majorly focusing on pieces of evidence-based research. Adequate care and treatment are found to have positive impacts on health outcomes.
Analysis
PE is a life-threatening condition that claims up to 30,000 lives annually. As previously stated, roughly one-third of PE-related fatalities happen during the first hour. Due to the wide variety of symptoms as well as manifestations, PE may be exceedingly difficult to detect. While the clinical manifestations vary considerably, some of the most typical symptoms are tachycardia, chest discomfort, breathlessness, hypoxemia, Low blood pressure, and shock. Additionally, various risk factors for PE exist. These risk factors include immobility, past myocardial injury and cerebrovascular disease, or current trauma. Although early symptoms include acute respiratory difficulties, the primary deleterious consequences of PE are on the cardiac system in terms of the blood clot occluding the pulmonary capillaries.
In the health industry, the treatment and care of individuals with PE are critical. As several studies have shown, drugs include a variety of blood thinners as well as clot dissolvers. Anticoagulants are the most often prescribed blood thinners. These medications inhibit present emboli from growing in size and additional clots from developing as the body attempts to dissolve the clots. Heparin is a commonly prescribed anticoagulant that may be administered intravenously or subcutaneously. It operates rapidly and is frequently used in conjunction with tablet anticoagulants, like warfarin, for many days before it gets effective, which may take multiple days. The current oral anticoagulants are much more effective and have fewer adverse effects when used with other drugs.
Additionally, most benefit from being administered orally, eliminating the necessity for heparin overlapping. However, these anticoagulants are associated with adverse risks, the most frequent of which is bleeding. When it comes to clot dissolvers, thrombolytics are the most often suggested. Although clots usually disintegrate independently, thrombolytics administered by vein may occasionally disintegrate lumps fast. Due to the risk of quick and heavy bleeding, such clot-busting medicines are often kept for the matter of life-threatening conditions.
However, some studies show that therapy may require surgical treatments such as clot excision or vein filtering. Dazley et al., for example, assert that anticoagulant drugs cause bleeding, necessitating emergency surgery. According to these experts, if a patient has a significant, potentially life-threatening embolism in the lungs, a physician may recommend extracting it with a slender, flexible tube inserted through the patient’s blood arteries. Additionally, a catheter may be used to place a filtration inside the body’s primary vein, that is, the inferior vena cava, which connects the legs to the heart’s right atrium. This filtration may help prevent blood clots from reaching the lungs. According to some scholars, catheter therapy is usually reserved for patients who cannot tolerate anticoagulant medications. Also, it is preserved for those with recurring clots following anticoagulant therapy. Certain filters may be deleted when they are no longer required. Additionally, another set of experts believes that frequent monitoring of patients’ health is crucial for improved health results. This type of care entails supportive care and treatment of the disease that resulted in the myocardial injury. Supportive care involves sufficient blood oxygenation through oxygen administration or reducing pain to improve respiration comfort.
The above analysis clearly shows that PE is a hazardous and urgent condition that requires immediate attention. Though numerous drugs have been offered, treating the sickness is challenging due to the ailment’s difficulties in diagnosis. As a result of this, I can recommend that more effective tools be produced for diagnostic reasons. Additionally, I may propose that folks undergo periodic testing to aid early discovery and treatment. Further, I suggest that these patients get effective treatment, including a well-balanced diet, regular cardiac monitoring, and frequent exercise.
Evidence
Several studies have identified numerous strategies for preventing PE in high-risk patients, most of which center on the use of lower vena cava filtration or anticoagulation. For example, Weinstein, Deshwal, and Brosnahan (2021) assert that anticoagulation treatment reduces death in patients having PE. Dalen & Alpert (2020) state that most patients suffering from PE are managed with at least three months with just an injectable anticoagulant. Anticoagulants can be administered intravenously or parenterally (Lopez et al., 2021). Intake includes directly oral anticoagulants or Vitamin K antagonists. The most prescribed DOACs are apixaban and rivaroxaban. On the other side, the most prescribed vitamins are acenocoumarin and Warfarin (Lopez et al., 2021).
Surgical therapy is also advised as an effective technique of PE treatment. In most acute cases of PE, surgical embolectomy is performed using cardiac surgery. This is proceeded by dissection of two major pulmonary arteries then excision or evacuation of new emboli (Konstantinides et al., 2020). Lopez et al. (2021) state that surgical therapy for PE consists of either open PE or catheter-directed thrombolytic therapy. Catheter-directed therapy is the ideal therapeutic method for individuals with high-risk PE who cannot receive thrombolysis or is a less intrusive option to surgery embolectomy. Treatments with a hybrids catheter may help lower fast heart rates, increase PA pressure, and enhance gaseous exchange indicators and results (Yamamoto, 2018). According to Dalen & Alpert (2020), this embolectomy procedure is routinely utilized in people with chronic PE. Additionally, it is conducted in individuals who are not suitable for thrombolysis (Yamamoto, 2018). Embolectomy surgery may be used to swiftly re-establish pulmonary blood circulation and treat acute blockage (Weinstein, Deshwal & Brosnahan, 2021).
Additional therapies include: respiratory support, which ensures tissue oxygenation prevents organ failure; intravenous fluids therapy, vasopressors, and extracorporeal oxygenation (Lopez et al., 2021). These medications are quite successful in preventing and treating PE. For example, diuretics are related to a reduction in the intensity of PE in cognitively normal individuals with PE without impairing kidney function; this might be owing to a reduction in RV and secondary vein obstruction (Lopez et al., 2021). Additionally, vasopressor medication assists in maintaining mean artery pressures higher than 65 mmHg (Weinstein, Deshwal & Brosnahan, 2021). Additionally, cardiopulmonary assistance is beneficial in individuals with a greater risk of PE or respiratory failure (Konstantinides et al., 2020).
Conclusion
Pulmonary Embolism is a severe illness with a high frequency. Though there are many counterarguments on the disease, treatment, and care for patients with this illness are vital. Some treatments found to be effective include: anticoagulation therapies, surgical treatment, vasopressors, and frequent monitoring of the patient. Though these treatments are of significant efficacy, there are still high mortality rates related to the illness. Therefore, more research is needed to identify possible treatments for more effective outcomes.
References
Dalen, J. E., & Alpert, J. S. (2020). Diagnosis and Treatment of Pulmonary Embolism: What Have We Learned in the Last 50 Years?. The American Journal of Medicine, 133(4), 404-406. https://www.amjmed.com/article/S0002-9343(19)30804-6/fulltext
Konstantinides, S. V., et al. (2020). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary Embolism developed in collaboration with the European Respiratory Society (ERS) The Task Force for diagnosing and managing acute pulmonary Embolism of the European Society of Cardiology (ESC). European heart journal, 41(4), 543-603. https://academic.oup.com/eurheartj/article-abstract/41/4/543/5556136
Lopez, E.Z. et al. (2021). Management of Pulmonary Embolism in the Intensive Care Unit. Clinical Hematology, 21.6. Retrieved from: https://healthmanagement.org/uploads/article_attachment/icu6-management-of-pulmonary-embolism-in-the-intensive-care-unit.pdf
Weinstein, T., Deshwal, H., & Brosnahan, S. B. (2021). Advanced management of intermediate-high risk pulmonary embolism. Critical Care, 25(1), 1-8. Retrieved from: https://link.springer.com/article/10.1186/s13054-021-03679-2
Yamamoto, T. (2018). Management of patients with high-risk Pulmonary Embolism: a narrative review. Journal of intensive care, 6(1), 1-9. https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0286-8
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