Massive pulmonary embolism (PE)

Massive pulmonary embolism (PE)
Always suspect pulmonary embolism (PE) in sudden collapse 1-2wks after surgery. Death rate in England and Wales: 30,000-40,000/yr.
Mechanism
Venous thrombi, usually from DVT, pass into the pulmonary circulation and block blood flow to lungs. The source is often occult.

Risk factors
Malignancy.
Surgery especially pelvic.
Immobility.
The Pill (there is also a slight risk attached to HRT).
Previous thromboembolism and inherited thrombophilia.

Prevention
Early post-op mobilization is the simplest method; consider:
Antithromboembolic (TED) stockings.
Low molecular weight heparin prophylaxis SC.
Avoid contraceptive pill if at risk, eg major or orthopaedic surgery.
Recurrent PEs may be prevented by anticoagulation, vena caval filters are of limited use, and should be combined with anticoagulation.