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DRG Category: 176
Mean LOS: 7.1 days
Description MEDICAL: Pulmonary Embolism with Major CC
Pulmonary embolism (PE) is a potentially life-threatening condition in which a free-flowing blood clot (embolism) becomes lodged within the pulmonary vasculature. PEs are frequent occurrences with the incidence of venous thromboembolism as high as 1 per 1,000 people. Approximately 650,000 cases of PE are reported yearly, and approximately 60% of patients who die in a hospital are found to have a PE on autopsy. It is viewed as the most commonly missed diagnosis in the elderly.
When an embolism becomes lodged within a pulmonary vessel, platelets accumulate around the thrombus and trigger the release of potent vasoactive substances. The pulmonary vasculature constricts, which leads to an increased pulmonary vascular resistance, increased pulmonary arterial pressure, and increased right ventricular workload. Blood flow abnormalities result in a ventilation/perfusion mismatch that is initially dead-space ventilation (ventilation with no perfusion). As atelectasis occurs, shunting (perfusion without ventilation of the alveolus) results. If the right side of the heart (accustomed to pumping out against a relatively low-resistance pulmonary circuit) cannot empty its volume against the increased pulmonary vascular resistance, right-sided heart failure occurs. Ultimately, cardiac function may deteriorate with decreased cardiac output, decreased systemic blood flow, and shock.