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Example text
Treatment Investigation Electrocardiogram (ECG) ECG changes are not diagnostic. Most frequently there is sinus tachycardia. There might or might not be signs of right heart strain such as right bundle branch block. Arterial blood gas analysis Arterial blood gas analysis demonstrates hypoxaemia, often with hypocapnia, the result of increased respiratory drive 'blowing off' more carbon dioxide. Radiology A chest radiograph is rarely diagnostic. Most changes seen are non-specific with opacification secondary to atelectasis and possibly a pleural effusion.
However, moderate-sized emboli can cause lung infarction with the accompanying symptoms of pain, haemoptysis and more severe shortness of breath. Where infarction has occurred a pleural rub may be present on auscultation. Large and massive PE constitutes a medical emergency and resuscitation might be required. Prevention of blood reaching alveoli results in profound hypoxaemia, and prevention of venous return to the left side of the heart can give a precipitous fall in cardiac output, shock and cardiac arrest.
Symptomatic DVT causes swelling and pain in the affected leg. This can be associated with engorged superficial veins and warmth with a tense and tender calf. Irrespective of whether symptomatic or asymptomatic, a clot can be cast off from a DVT and float freely in the circulation until it lodges in the pulmonary vessels. This is known as a pulmonary embolus (PE) and can be the cause of sudden collapse and unexpected postoperative death. Investigation Clinical diagnosis is notoriously unreliable, with accuracy figures of around 50% even for experienced clinicians.