June 4, 2023

Pulmonary Embolism can have significant effects on pulmonary and cardiac function. Researchers examined whether diuresing excess fluid with furosemide would improve outcomes in pulmonary embolism.

Hello and welcome to furosemide in pulmonary embolus my name is david woodruff i’m the editor of critical care nursing made incredibly easy i hope to make this incredibly easy for you too pulmonary embolism is a condition that can cause the patient to have some serious effects including shock hypotension cardiac arrest and even death so it’s important that

We have ways to be able to deal with some of these outcomes from pulmonary embolism because we can’t always get rid of that embolus right away and we have to wait for the body to start to break it down so let’s take a look at what a pulmonary embolus is so you can see here is a blood clot and it’s coming back up through the venous circulation typically these

Happen in the lower extremities and specifically in the leg so that embolus is flowing back up through the the venous circulation coming back up to the heart it goes through the heart then and it ends up getting caught in the pulmonary vasculature so this is a pulmonary embolus now that embolus there is going to block the circulation to part of the lung which

Is then going to cause the patient to have problems with gas exchange and also the backup of fluid caused by the resistance of that embolus so now if we take a look at that embolus from the standpoint of the backup of fluid that’s occurring we can see that the blood is going to start to back up into the heart back into the ventricle because normally we would have

Blood flowing through those vessels through the lung coming back to the left side now though because this embolus is blocking the vessel some of that blood is being pushed back into the heart and that’s going to cause distension of the ventricles and decrease cardiac output that’s where we get our shock from and the hypotension all of these things are going to

Cause decreased cardiac output and that’s going to lead to the patient developing shock okay so where does furosemide fit in here friosimide is a diuretic why would we give a diuretic to somebody who’s already in shock who already has a low blood pressure that doesn’t seem to make a lot of sense but if you think about the backing up of fluid this causes this

Over distension of the ventricle then it starts to make a little bit more sense if we can get rid of some of that venous return that’s coming to the heart then hopefully we will be able to help that patient to be able to have a better cardiac output in a study by limb at all they took a look at using furosemide 80 milligrams iv in patients who had a fairly

Large type of pulmonary embolus one that was sufficiently large that it was causing the patient to have symptoms what the idea was again is if we can decrease the fluid volume that will decrease the venous return to the heart and then decrease our ventricular distension so what did they find if you take a look at the diagram here you can see that with placebo

They had about a 37 percent chance of avoiding some of those bad outcomes just by doing the usual care however when we gave those patients who were already a little hemodynamically unstable who had a fairly large pulmonary embolus when we gave them furosemide there was a 51 percent chance that they would avoid having decompensation and declining so obviously

We can see that there was an improvement in the results as a result of using that furosemide this is the study is done by lima at all it’s called diuretic versus placebo and intermediate risk acute pulmonary embolism a randomized clinical trial in case you’d like to pull that article and to read more about the study that they did well thank you for joining me

For furosemide and pulmonary embolus my name is david woodruff and until next time bye now

Transcribed from video
Furosemide in Pulmonary Embolism By David WoodruffliveBroadcastDetails{isLiveNowfalsestartTimestamp2022-03-06T170027+0000endTimestamp2022-03-06T170702+0000}