Pulmonary embolism in children

The development of pulmonary embolism is facilitated by factors such as bed rest, heart disease, postoperative pathology, fractures, varicose veins, and obesity.

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Symptoms of pulmonary embolism in children

The symptoms of pulmonary embolism depend on the degree of damage to the vessels of the pulmonary artery system. Patients complain of shortness of breath, chest pain, cough, hemoptysis. Objectively, tachypnea, cyanosis, tachycardia, swelling of the veins of the upper half of the body, and an enlarged liver are detected. Ascultatory changes resemble the picture of pneumonia, pleural friction noise is detected at a later stage. In severe cases, sudden loss of consciousness, convulsions, signs of acute vascular or cardiovascular failure (cardiogenic shock) occur. The clinical picture may be erased, which often leads to untimely diagnosis or failure to recognize the disease. The electrocardiogram may show infarction-like changes with signs of overload of the right heart (P-pulmonale, increase in the R wave in leads II, III, aVF, V ₁, V ₂, pronounced S wave in leads V ₅ -V ₆, etc.), but without a pathological Q wave, and in the presence of an S wave. From the results of additional research methods, a decrease in pQ and infiltrates on a chest X-ray are of diagnostic value.

Treatment of pulmonary embolism in children

Emergency care for pulmonary embolism in children and adolescents depends on the severity of the disease. In the fulminant form, primary cardiopulmonary resuscitation is performed, tracheal intubation and artificial ventilation, oxygen therapy with 50% oxygen are performed. For pain relief, narcotic analgesics are administered [1% morphine solution (0.1-0.15 mg/kg) or 1-2% trimeperidine solution (0.1 ml per year of life)]. To relieve psychomotor agitation, diazepam is administered intravenously at a dose of 0.3-0.5 mg/kg (10-20 mg). For neuroleptanalgesia, 0.005% fentanyl solution (1-2 ml), 1% morphine solution or 1-2% trimeperidine solution can be used, if they have not been administered previously, with 1-2 ml of 0.25% droperidol solution.

Thrombolytic therapy during the first 2 hours is carried out using streptokinase at a dose of 100,000-250,000 U intravenously by drip over an hour. For the same purpose, sodium heparin can be used intravenously at a dose of 200-400 U/kg (day) under the control of a coagulogram, dipyridamole (5-10 mg/kg).

For infusion therapy, colloid and crystalloid solutions are used (0.9% sodium chloride solution, 5-10% dextrose solution, Ringer's solution are administered at a rate of 10-20 ml/kg per hour). For inotropic support, dopamine 5-15 mcg/(kg x min) is slowly administered intravenously by drip (50 mg is diluted in 500 ml of infusion saline solution). In this case, systolic blood pressure in adolescents must be maintained at a level of at least 100 mm Hg.

In the event of ventricular arrhythmia due to the risk of ventricular fibrillation, it is necessary to prescribe a 1% lidocaine solution (1-1.5 mg/kg). Patients are hospitalized in the intensive care unit.