Advice after your nerve block for surgery
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During the assessment in the Emergency Department (ED) or hospital you have been diagnosed with a possible Pulmonary Embolism (PE): this is a blood clot within your lung(s).
The doctors have assessed you and have decided it is safe to send you home.
Prior to leaving the hospital you will be given either:
- Dalteparin (Fragmin) which is administered as a subcutaneous injection (into the fatty layer just below the surface of the skin in your tummy), this is to protect you from further embolic (blood clotting) events. You will require these injections once or twice daily depending on your weight.
- or a Direct Oral Anti-Coagulant (DOAC), which is a tablet that thins the blood and protects against further clotting events. The 2 DOACs in widespread use are Apixaban and Rivoroxaban,
- You may be given an appointment to attend the Ambulatory Emergency Care Unit (AECU) on the next working day if you were diagnosed in ED (the AECU is open Monday - Friday 10.00am – 6.00pm).
- On the AECU one of the senior clinical staff will explain your assessment and treatment plan, organise diagnostic tests for you if required and commence you on treatment with anticoagulation therapy (medication that makes your blood less likely to clot), depending on the results of the tests.
What is a Pulmonary Embolism?
A pulmonary embolism (PE) is a blood clot that has lodged inside one of the arteries in the lungs. Depending on the size of this clot, a pulmonary embolism can cause damage to lung tissue and affect the proper functioning of the damaged lung. This can be a serious condition; but doctors use a series of assessments to establish if you need tests in hospital or whether this can be done as an outpatient.
Where do clots come from?
Blood clotting is a normal process. For example, if you cut yourself, eventually the blood clots and bleeding from the injured area stops. This process is necessary to ensure that damaged areas are repaired.
Occasionally though, this mechanism malfunctions and blood clots can form inside the blood vessels when the blood flow has merely slowed down or become sluggish. Clots like these generally form in the large deep veins of the leg. This is called a deep vein thrombosis (DVT). Sometimes either all or part of the DVT breaks away and travels via the circulation, passing through the heart and lodging in the lung. This is called a pulmonary embolism (PE).
An embolus is a blood clot that has moved from the location where it was formed. Once it travels through the blood stream, it can obstruct a blood vessel, causing an interruption in the supply of blood.
What are the symptoms of a Pulmonary Embolism?
The symptoms of pulmonary embolism (PE) depend on a number of factors, including the location of the blockage and the size of the area affected by the lack of blood supply.
Some of the possible signs and symptoms of pulmonary embolism are:
• Feelings of being breathless that comes on suddenly with no apparent explanation.
• Pains in the chest when you breathe in.
• Feeling faint.
• Coughing up blood-stained phlegm.
How is a PE diagnosed?
A PE can be difficult to diagnose, as many other conditions can give rise to similar symptoms. A diagnosis of PE is made based on your symptoms, clinical examination, blood tests and lung scan.
How is a PE treated?
A PE is treated with anticoagulant medication. Anticoagulants are drugs that stop clots forming. At first, you may be given heparin injections. Once the diagnosis is confirmed you may be started on warfarin tablets or one of the new agents called Direct Oral Anti-Coagulants (DOACs). As Warfarin takes a few days to start working, the heparin injections are continued; however, once the warfarin has taken effect, the heparin injections can be stopped. This is not required for the DOACs.
Will this anticoagulation medication break down the clot?
Neither the heparin nor the warfarin have any direct effect on the blood clot itself, your body will break that down over time.
Anticoagulants work to prevent the clot becoming any larger and moving again. They also stop new clots forming at a time when you would be at risk of this.
How long do I need to stay in hospital?
This depends on how ill you are. Some patients have mild symptoms and feel reasonably well after a PE. If this is the case then you would usually stay a few days; we are hoping to introduce a supported early discharge scheme to further reduce the hospital stay.
Other patients have large clots and can require special drugs to dissolve the clot, or are very breathless and require oxygen treatment for a few days. If this is the case, you will need to stay in hospital until you are well enough to go home.
Why did I get a PE?
For many patients the reasons for having a PE are unknown. Below are some factors that are known to increase the risk of blood clots forming:
- Previous history of blood clots
- Advancing age
- Immobility
- Recent surgery especially orthopaedic or major abdominal surgery
- Recent immobilization of leg with a plaster of Paris
- Recent long distance travel by air, coach or car
- Recent admission to hospital with an acute illness or infection
- Pregnancy / Contraceptive pill / HRT
- Some genetic predispositions
- There are some underlying medical conditions that can increase the risk of clots forming; these include inflammatory bowel disease and cancers.
Having a PE DOES NOT MEAN THAT YOU HAVE ONE OF THESE CONDITIONS.
The follow up that is arranged after the diagnosis is confirmed is to establish if further tests are needed to investigate the cause of the PE.
However, the large majority of patients sustain a PE for no identifiable reason. This is called a spontaneous or idiopathic PE.
Useful Websites
• www.nhsdirect.nhs.uk
• www.emedicinehealth.com
• www.patient.co.uk
• www.thrombosis.co.uk
Contact us
If you have any queries relating to this information, please contact the Respiratory medicine service.
About this information
Service:
Respiratory medicine
Reference:
W/028
Approval date:
17 January 2025
Review date:
1 January 2028
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.