Why do patients with pulmonary embolism feel sleepy?

Written by Yuan Qing
Pulmonology
Updated on September 26, 2024
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Patients with pulmonary embolism primarily suffer from emboli within the venous system, which travel back to the right heart and then become lodged in the pulmonary artery, forming a pulmonary artery thrombus. This reduces pulmonary blood flow and impacts the exchange of air in the lungs, leading to hypoxia in the patient. Following hypoxia, the brain tends to enter a sleepy state, thus many patients with pulmonary embolism exhibit sleepiness. This sleepiness is related to the pathophysiological mechanisms of pulmonary embolism. At this point, it is crucial to provide sufficient oxygen to the patient to address their hypoxemia. Ultimately, the most fundamental treatments are prompt thrombolysis or anticoagulation therapy to resolve the embolus, addressing the condition fundamentally.

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Written by Wei Shi Liang
Intensive Care Unit
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Is pulmonary embolism related to pneumonia?

If unexplained shortness of breath, pleuritic chest pain, tachycardia, and decreased oxygen saturation occur, one should be highly vigilant about pulmonary embolism. Generally, pulmonary embolism has no direct relationship with pneumonia. High-risk factors for pulmonary embolism include obesity, prolonged immobilization, stroke, congestive heart failure, malignant tumor, inflammatory bowel disease, lower limb fracture, anesthesia time exceeding 30 minutes, and acquired or genetic hypercoagulable state. It usually manifests as difficulty breathing, rapid breathing, and pleuritic chest pain.

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Written by Wei Shi Liang
Intensive Care Unit
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Can a pulmonary embolism be detected by a CT scan?

CT can detect acute pulmonary embolism, using CT angiography, which is the preferred imaging method for diagnosing pulmonary embolisms. It mainly shows central filling defects, as well as eccentric and abdominal wall filling defects, and complete filling defects. A diagnosis of pulmonary embolism can be made through the visualization of these filling defects on a CT scan. Additionally, some indirect signs, such as pulmonary hypertension, right ventricular enlargement, and the common mosaic sign, can also be observed. These are characteristic CT manifestations of acute pulmonary embolism.

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Written by Li Jian Wu
Pulmonology
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Early symptoms of pulmonary embolism

In the early stages of pulmonary embolism, symptoms such as difficulty breathing, chest tightness, shortness of breath, and decreased oxygen saturation can occur. Early signs may include chest pain, as chest pain is often an initial symptom of pulmonary embolism. Sometimes the pain can be severe, and some patients may experience coughing, dry cough, and even cough up blood. There may also be symptoms of short exhalation and difficulty breathing, especially in patients with main trunk blockages, where the difficulty in breathing can be very pronounced. In more severe cases, some may experience fainting, suddenly collapsing while walking.

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Written by Yuan Qing
Pulmonology
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The difference between pulmonary embolism and pulmonary congestion

Pulmonary embolism and pulmonary congestion are two completely different diseases. Pulmonary embolism is mainly caused by the thrombosis of the venous vessels entering the pulmonary artery, thereby causing restricted blood flow in the pulmonary artery and leading to pulmonary embolism. Pulmonary congestion is often due to left heart failure, where the blood flow in the lungs cannot return to the left heart, causing the blood to be retained and congested in the lungs, forming this disease. However, they do have some similarities, such as presenting symptoms of difficulty breathing, shortness of breath, low blood pressure, shock, etc. But through diagnosis and additional examinations, these two diseases can be clearly differentiated. Therefore, careful differentiation is required in clinical practice because the treatments for the two diseases are completely different. If misdiagnosed, the treatment could be incorrect, leading to serious consequences from mistreatment.

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Written by Wei Shi Liang
Intensive Care Unit
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How long does the treatment for pulmonary embolism take?

The timing of pulmonary embolism treatment mainly depends on the severity of the pulmonary embolism. The main goals of pulmonary embolism treatment are to save lives by addressing life-threatening right heart dysfunction and obstructive shock caused by the pulmonary embolism, to re-establish pulmonary vascular patency, restore lung tissue perfusion, and prevent the recurrence of pulmonary embolism. Main treatment methods include: respiratory and circulatory support, anticoagulation, thrombolysis, interventional or surgical removal of blood clots, placement of inferior vena cava filters, etc. General management: Patients who are highly suspected or diagnosed with pulmonary embolism should be closely monitored, tracking changes in respiration, heart rate, blood pressure, venous pressure, electrocardiogram, and blood gases to prevent the dislodgement of clots again. Absolute bed rest is required, and care should be taken not to overly bend the lower limbs, maintain bowel regularity, and avoid straining. For patients experiencing anxiety and panic symptoms, reassurance should be provided, along with appropriate use of sedatives. If there is chest pain, analgesics may be administered. For symptoms like fever and cough, corresponding symptomatic treatments should be given. To prevent lung infections and treat phlebitis, antibiotics may be used. Additionally, support treatments for respiratory and circulatory functions, as well as anticoagulation therapy, should be provided.