Introduction Introduction procedures associated with pulmonary embolism hip fracture elective total hip arthroplasty the greatest risk of activation of the clotting cascade during total hip arthroplasty occurs during insertion of the femoral component elective total knee arthroplasty spine fracture with paralysis early diagnosis and treatment is most important factor for survival Presentation Saddle emboli can present with death PE should be suspected in postoperative patients with acute onset pleuritic pain and dyspnea tachypnea tachycardia Evaluation EKG; S1Q3T3 most common finding sinus tachycardia ABG Imaging CXR (usually normal, may show a prominent hilum) nuclear medicine ventilation-perfusion scan (V/Q) most helpful for dye-sensitive patients pulmonary angiography is gold standard helical chest CT widely considered first line imaging modality Treatment Nonoperative continuous IV heparin infusion followed by warfarin therapy indications in most cases as first line treatment technique continuous IV heparin infusion typically given for 7-10 days warfarin therapy typically given for 3 months monitor heparin therapy with PTT (partial thromboplastin time) monitor coumadin therapy with INR (international normalized ratio) thrombolytics indications in specific cases technique see anticoagulation Complications