NON-Thrombotic Pulmonary Embolism (clin.med)

What are some non-thrombotic types of pulmonary embolisms? (4)

1. air embolism 2. fat embolism 3. amnionic fluid embolism 4. tumor embolism

Where do fat emboli come form? - How would the patient manifest with a pulmonary fat emboli? (2) - what does the prognosis look like?

1. bone marrow fat from long bone 2. bone marrow fat from pelvic fracture - 1. ARDS picture 2. neuro deficits - most recover fully

What two conditions must exist in order for an air embolism to occur?

1. direct communication between a source of air and the vasculature 2. pressure gradient must favor the passage of air into the circulation rather than bleeding form the vessel ( i.e sub-atmospheric pressure)

How is a pulmonary air embolism treated? - What does a high FiO2 do in the case of a pulmonary air embolism?

1. put the patient in trendelenberg position to keep air form entering the pulmonary artery 2. supportive care: pressors, ventilation, IVF - hastens washout of air

What are three general categories of causes for air embolism?

1. surgery/trauma 2. intravascular catheterization 3. barotrauma

This non-thrombotic type of pulmonary embolism is rare, unpredictable and catastrophic!!

amnionic fluid embolism - high maternal and fetal mortality and morbidity

Describe how a pulmonary air embolism is usually "diagnosed"

must have a high index of suspicion. Air often rapidly absorbs and it is a diagnosis of exclusion. - the diagnosis is confirmed if air is demonstrated in the vascular space

This type of non-thrombotic PE looks like a PE but is hard to diagnose. - What type of prognosis does it have?

tumor embolism: tiny pieces of tumor enter blood vessels and travel to the lungs - poor prognosis