1. The document discusses pulmonary embolism, including its definition, risk factors, signs and symptoms, diagnostic tests, and treatment options.
2. Common diagnostic tests mentioned are CT scans, ventilation-perfusion scans, pulmonary angiograms, and MRAs. Treatment involves respiratory support, hemodynamic support like thrombolysis, and anticoagulation typically with heparin or warfarin.
3. Complications of anticoagulation therapy discussed include bleeding, heparin-induced thrombocytopenia, and osteoporosis from prolonged use. Monitoring of anticoagulation levels and potential drug interactions is also addressed.
- Pulmonary embolism affects approximately 500,000 individuals per year in the US, with around 50,000 deaths annually.
- Deep vein thrombosis accounts for over 95% of pulmonary emboli. Risk factors for DVT and thus PE include surgery, trauma, cancer, prolonged immobility, and genetic or acquired hypercoagulable states.
- Diagnosis is suggested by symptoms like dyspnea and chest pain but requires imaging tests like CT pulmonary angiogram, ventilation-perfusion scanning, or echocardiogram to confirm the presence of emboli. Treatment involves anticoagulation with heparin or warfarin.
This document discusses pulmonary embolism (PE), a potentially lethal condition caused by blood clots in the lungs. PE is often missed due to nonspecific symptoms but can lead to death if untreated. Risk factors include immobilization, surgery, cancer, pregnancy, and oral contraceptives. Symptoms range from nonspecific chest pain to circulatory collapse. Diagnosis involves tests like CT scans, VQ scans, echocardiograms and D-dimer levels. Treatment involves oxygen, anticoagulants like blood thinners, and potentially thrombolytics for severe cases. Outcomes depend on early detection and treatment, but PE can still lead to complications like pulmonary hypertension if not addressed.
Pulmonary embolism - Diagnosis and managementDr Vivek Baliga
Pulmonary embolism is a common problem seen in medical practice. This presentation by Dr Vivek Baliga discusses the basic aspects and evidence behind current management.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include cancer, obesity, pregnancy, prolonged immobility, and genetic hypercoagulable states. Diagnosis involves assessing clinical probability, d-dimer testing, imaging like CT scans or V/Q scans, and echocardiography. Treatment consists of anticoagulants like heparin or warfarin to prevent further clotting while the body breaks down existing clots.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of cases resulting in PE. Risk factors include immobilization, surgery, cancer, and estrogen use. Diagnosis involves assessing clinical probability based on symptoms and risk factors, followed by tests like D-dimer, chest imaging, ultrasound, V/Q scan, CT, or angiogram. Treatment aims to prevent further clotting with anticoagulants like heparin and warfarin, provide supportive care, and in some severe cases utilize thrombolysis or embolectomy.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include older age, cancer, obesity, surgery, trauma, and genetic or acquired hypercoagulable states. Diagnosis involves assessing clinical probability, blood tests like D-dimer, imaging like CT scans or ventilation-perfusion scans, and echocardiography. Treatment focuses on anticoagulation to prevent further clotting and allow natural lysis, along with supportive care and thrombolysis or embolectomy in severe cases.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include cancer, obesity, pregnancy, prolonged immobility, and genetic predispositions. Diagnosis involves evaluating symptoms, physical exam findings, blood tests like D-dimer, imaging like CT scans and V/Q scans, and echocardiograms. Treatment focuses on anticoagulation with heparin or warfarin to prevent further clotting while the body breaks down existing clots.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of cases resulting in PE. Risk factors include cancer, obesity, pregnancy, prolonged immobility, and genetic predispositions. Diagnosis involves evaluating symptoms, medical history, imaging tests like CT scans and ventilation-perfusion scans, and blood tests. Treatment focuses on anticoagulation to prevent further clotting and allow natural dissolution, with thrombolysis or embolectomy for severe cases.
- Pulmonary embolism affects approximately 500,000 individuals per year in the US, with around 50,000 deaths annually.
- Deep vein thrombosis accounts for over 95% of pulmonary emboli. Risk factors for DVT and thus PE include surgery, trauma, cancer, prolonged immobility, and genetic or acquired hypercoagulable states.
- Diagnosis is suggested by symptoms like dyspnea and chest pain but requires imaging tests like CT pulmonary angiogram, ventilation-perfusion scanning, or echocardiogram to confirm the presence of emboli. Treatment involves anticoagulation with heparin or warfarin.
This document discusses pulmonary embolism (PE), a potentially lethal condition caused by blood clots in the lungs. PE is often missed due to nonspecific symptoms but can lead to death if untreated. Risk factors include immobilization, surgery, cancer, pregnancy, and oral contraceptives. Symptoms range from nonspecific chest pain to circulatory collapse. Diagnosis involves tests like CT scans, VQ scans, echocardiograms and D-dimer levels. Treatment involves oxygen, anticoagulants like blood thinners, and potentially thrombolytics for severe cases. Outcomes depend on early detection and treatment, but PE can still lead to complications like pulmonary hypertension if not addressed.
Pulmonary embolism - Diagnosis and managementDr Vivek Baliga
Pulmonary embolism is a common problem seen in medical practice. This presentation by Dr Vivek Baliga discusses the basic aspects and evidence behind current management.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include cancer, obesity, pregnancy, prolonged immobility, and genetic hypercoagulable states. Diagnosis involves assessing clinical probability, d-dimer testing, imaging like CT scans or V/Q scans, and echocardiography. Treatment consists of anticoagulants like heparin or warfarin to prevent further clotting while the body breaks down existing clots.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of cases resulting in PE. Risk factors include immobilization, surgery, cancer, and estrogen use. Diagnosis involves assessing clinical probability based on symptoms and risk factors, followed by tests like D-dimer, chest imaging, ultrasound, V/Q scan, CT, or angiogram. Treatment aims to prevent further clotting with anticoagulants like heparin and warfarin, provide supportive care, and in some severe cases utilize thrombolysis or embolectomy.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include older age, cancer, obesity, surgery, trauma, and genetic or acquired hypercoagulable states. Diagnosis involves assessing clinical probability, blood tests like D-dimer, imaging like CT scans or ventilation-perfusion scans, and echocardiography. Treatment focuses on anticoagulation to prevent further clotting and allow natural lysis, along with supportive care and thrombolysis or embolectomy in severe cases.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include cancer, obesity, pregnancy, prolonged immobility, and genetic predispositions. Diagnosis involves evaluating symptoms, physical exam findings, blood tests like D-dimer, imaging like CT scans and V/Q scans, and echocardiograms. Treatment focuses on anticoagulation with heparin or warfarin to prevent further clotting while the body breaks down existing clots.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of cases resulting in PE. Risk factors include cancer, obesity, pregnancy, prolonged immobility, and genetic predispositions. Diagnosis involves evaluating symptoms, medical history, imaging tests like CT scans and ventilation-perfusion scans, and blood tests. Treatment focuses on anticoagulation to prevent further clotting and allow natural dissolution, with thrombolysis or embolectomy for severe cases.
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include older age, cancer, obesity, surgery, trauma, and genetic or acquired hypercoagulable states. Diagnosis involves assessing clinical probability based on symptoms and risk factors, then confirming with tests like D-dimer, chest imaging, ventilation-perfusion scanning, pulmonary angiography, or CT pulmonary angiography. Treatment focuses on anticoagulation to prevent further clotting while allowing natural lysis of existing thrombi.
This document discusses the pathophysiology and treatment of acute pulmonary embolism (PE). It covers:
- The pathophysiological effects of PE on right ventricular function and hemodynamics.
- Clinical prediction rules and diagnostic strategies for PE including D-dimer testing and imaging modalities like CT, VQ scan, and angiography.
- Treatment options for PE including anticoagulants like heparin, low molecular weight heparin, fondaparinux, and newer oral agents; as well as thrombolytics, vena cava filters, and embolectomy. LMWH is recommended as first-line treatment due to superior safety compared to unfractionated heparin
This document provides an overview of pulmonary embolism (PE). It discusses the historical context, pathophysiology, risk factors, clinical presentation, diagnostic testing and treatment of PE. Some key points include:
- PE is a common cause of preventable death, with over 600,000 cases annually in the US.
- Virchow's triad of hypercoagulability, stasis, and endothelial injury contributes to the development of PE.
- Clinical presentation is often nonspecific, and the classic triad of symptoms occurs in less than 20% of cases.
- Diagnostic testing includes D-dimer, chest CT, ventilation-perfusion scanning and pulmonary angiography. Early treatment with antico
Acute pulmonary embolism is a form of venous thromboembolism that occurs when a blood clot breaks off and lodges in the pulmonary arteries of the lungs. The clinical presentation of PE can be variable and non-specific, making diagnosis challenging. It is important to efficiently evaluate patients suspected of having a PE to diagnose and treat it quickly in order to reduce morbidity and mortality. Treatment involves hemodynamic and respiratory support, initial anticoagulation with drugs like heparin, and potentially reperfusion therapies for more severe cases including thrombolysis or embolectomy.
1. Pulmonary embolism is an obstruction of the pulmonary artery or its branches by a thrombus originating in the venous system or right side of the heart.
2. The annual incidence of PE ranges from 23-69 cases per 100,000 population in India. Globally, the incidence of venous thromboembolism remains relatively constant at 117 cases per 100,000 person-years.
3. Diagnosis involves using criteria like Wells criteria and PERC rule to determine pre-test probability, D-dimer testing, and imaging like CT pulmonary angiography or lung scan if needed based on risk level and test results. Management involves anticoagulation with heparin or low molecular weight he
This document discusses acute pulmonary embolism (PE), which results from blood clots (deep vein thromboses or DVTs) breaking off and traveling to the lungs. PE is a leading cause of preventable hospital death. The document covers risk factors for PE like immobility, surgery, cancer, and inherited conditions. It also discusses methods for diagnosing PE like the Wells criteria, D-dimer testing, chest imaging like CT scans, and treatment including anticoagulation and thrombolysis for hemodynamically unstable patients. Poor prognostic signs of PE include hypotension, cardiac biomarkers indicating injury, and imaging findings of right ventricular dysfunction. Prevention through appropriate DVT prophylaxis is emphasized.
This document discusses acute pulmonary embolism (PE), including its presentation, risk factors, diagnostic workup, and management. PE is a potentially life-threatening condition that is often missed or difficult to diagnose due to vague symptoms. Timely treatment is important as untreated PE has a 20-30% mortality rate. Diagnostic tests include D-dimer, CT pulmonary angiogram, ventilation-perfusion scan, and angiogram. Initial treatment involves anticoagulation with heparin or fondaparinux. Long-term anticoagulation with warfarin is recommended to prevent recurrence. Thrombolysis or embolectomy may be considered for massive PE with hemodynamic instability.
This document discusses pulmonary embolism (PE), including its definition, epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and management. Some key points:
- PE is an obstruction of the pulmonary artery or its branches by a thrombus originating in the venous system or right heart. It is a common cause of preventable death in hospitalized patients.
- The annual incidence of PE ranges from 23-69 cases per 100,000 people in India. Worldwide, the incidence of venous thromboembolism (which includes PE and DVT) is 117 cases per 100,000 person-years.
- Risk factors for PE include hereditary clotting disorders, immobil
The document discusses acute pulmonary embolism (PE). PE is common but difficult to diagnose, with nonspecific symptoms. It describes a case of a 48-year-old woman presenting with sudden dyspnea, tachycardia, and leg swelling who may have PE. Risk factors for PE include recent surgery or trauma, prolonged immobilization, and inherited or acquired hypercoagulable states. Diagnosis involves clinical scoring, D-dimer, imaging like CTPA, and treatment includes anticoagulation with heparin or warfarin.
This document discusses pulmonary embolism (PE). It notes that PE is a common disorder that can be deadly if left untreated. The presentation of PE is often vague and nonspecific. While the classic triad of symptoms is hemoptysis, dyspnea, and pleuritic pain, this occurs in less than 20% of patients. The document reviews risk factors, clinical features, diagnostic testing options including Wells criteria, imaging studies, D-dimer testing and their limitations. Treatment involves anticoagulation with heparin or warfarin to prevent clot extension and recurrence while educating patients.
PowerPoint presentation about pulmonary embolism -- Teaching at Zagazig university cardiology department ,
Egypt in 2013 by Islam Ghanem , assistant lecturer of cardiology
Pulmonary embolism (PE) is a potentially life-threatening condition with an estimated incidence between 0.5-3% in the general population. Risk factors include previous DVT, immobilization, surgery, cancer, and certain genetic conditions. Symptoms are nonspecific but commonly include dyspnea, chest pain, and cough. Diagnostic tests include D-dimer, CT pulmonary angiogram (CTPA), ventilation-perfusion scan, and pulmonary angiogram. Clinical decision rules like Wells criteria are used to determine pre-test probability to guide appropriate testing. The diagnostic algorithm involves using Wells criteria and D-dimer to determine if CTPA is needed, with CTPA used to confirm or exclude the diagnosis in
A V/Q scan evaluates ventilation and perfusion of the lungs to diagnose pulmonary embolism (PE). It involves inhaling a radioactive gas to assess ventilation and receiving an IV injection of radioactive albumin to assess perfusion. Mismatched defects indicate PE while matched defects can indicate lung disease. The PIOPED study established criteria for classifying scans as high, intermediate, or low probability of PE. A normal scan makes PE unlikely while a high probability scan makes PE very likely. Other tests for PE include CT pulmonary angiogram, pulmonary angiogram, and chest x-ray.
This document discusses acute pulmonary embolism, including its causes, symptoms, diagnosis, and treatment. It notes that PE is a leading cause of preventable hospital death and that diagnosis can be difficult due to non-specific symptoms. The diagnosis involves a clinical probability assessment, d-dimer test, and CT scan. Treatment depends on risk stratification and may involve anticoagulation, thrombolysis for massive PE, or placement of an IVC filter. Prevention through prophylaxis in at-risk patients is emphasized.
This document summarizes pulmonary embolism (PE), including its epidemiology, risk factors, pathophysiology, clinical features, diagnostic testing, and treatment. PE is the second most common cause of unexpected death, with risk factors including recent surgery, trauma, cancer, and inherited or acquired thrombophilias. Diagnosis involves assessing clinical probability then confirming with D-dimer, imaging like CT pulmonary angiogram, or lung scintigraphy. For acute PE, initial treatment is heparin or fondaparinux followed by long-term oral anticoagulation to prevent recurrence. New oral anticoagulants targeting factor Xa provide alternatives to warfarin.
A pulmonary embolism occurs when a blood clot or other material occludes the pulmonary artery or its branches. This most commonly results from a deep vein thrombosis in the lower leg that embolizes to the lung. When a PE occurs, it causes ventilation-perfusion mismatching in the lungs. Diagnosis is difficult due to nonspecific symptoms but evaluation involves a Wells criteria assessment, D-dimer testing, echocardiogram, and CT pulmonary angiogram. Treatment consists of anticoagulation with low molecular weight heparin or novel oral anticoagulants. Fibrinolytic therapy may be used in massive PEs. Prevention focuses on prophylaxis in high risk hospitalized patients.
Pulmonary Embolism & Deep Vein Thrombosis - Handout.pdfAbdirizakJacda
This document provides an overview of a 60-minute webinar on pulmonary embolism (PE) and deep vein thrombosis (DVT). The webinar aims to cover the pathophysiology, risk factors, and management of PE and DVT according to NICE guidelines, and provide high-yield facts relevant for exams. The webinar will include a case-based discussion of a 65-year-old female presenting with shortness of breath and chest pain who has risk factors for PE. Slides and recordings from the webinar will be available on the listed website.
This document discusses MDCT and pulmonary embolism (PE). It provides an overview of risk factors for PE, clinical signs and symptoms, diagnostic tests including CXR, V/Q scan and pulmonary CTA. It describes techniques for optimal pulmonary CTA and discusses findings of acute vs chronic PE, as well as non-thrombotic causes of PE like tumor embolism. Common pitfalls in PE CTA are outlined.
Pulmonary embolism (PE) is a blockage in the lungs caused by blood clots that travel from deep veins, usually in the legs. It is the third most common cause of death in hospitalized patients, with over 650,000 cases occurring per year in the US. Risk factors include immobilization, hypercoagulability, and recent surgery or trauma. Symptoms can include chest pain, shortness of breath, cough, or fainting. Diagnosis is confirmed through imaging tests like CT angiography or ventilation-perfusion scans. Treatment involves blood thinners like heparin, warfarin, or newer oral anticoagulants to prevent further clotting. Thrombolytic drugs
Pulmonary embolism (PE) is a common and potentially fatal condition where blood clots block arteries in the lungs. An estimated 5 million venous thromboses occur annually worldwide, with 10-30% of PE cases correctly diagnosed. Risk factors include older age, cancer, obesity, surgery, trauma, and genetic or acquired hypercoagulable states. Diagnosis involves assessing clinical probability based on symptoms and risk factors, then confirming with tests like D-dimer, chest imaging, ventilation-perfusion scanning, pulmonary angiography, or CT pulmonary angiography. Treatment focuses on anticoagulation to prevent further clotting while allowing natural lysis of existing thrombi.
This document discusses the pathophysiology and treatment of acute pulmonary embolism (PE). It covers:
- The pathophysiological effects of PE on right ventricular function and hemodynamics.
- Clinical prediction rules and diagnostic strategies for PE including D-dimer testing and imaging modalities like CT, VQ scan, and angiography.
- Treatment options for PE including anticoagulants like heparin, low molecular weight heparin, fondaparinux, and newer oral agents; as well as thrombolytics, vena cava filters, and embolectomy. LMWH is recommended as first-line treatment due to superior safety compared to unfractionated heparin
This document provides an overview of pulmonary embolism (PE). It discusses the historical context, pathophysiology, risk factors, clinical presentation, diagnostic testing and treatment of PE. Some key points include:
- PE is a common cause of preventable death, with over 600,000 cases annually in the US.
- Virchow's triad of hypercoagulability, stasis, and endothelial injury contributes to the development of PE.
- Clinical presentation is often nonspecific, and the classic triad of symptoms occurs in less than 20% of cases.
- Diagnostic testing includes D-dimer, chest CT, ventilation-perfusion scanning and pulmonary angiography. Early treatment with antico
Acute pulmonary embolism is a form of venous thromboembolism that occurs when a blood clot breaks off and lodges in the pulmonary arteries of the lungs. The clinical presentation of PE can be variable and non-specific, making diagnosis challenging. It is important to efficiently evaluate patients suspected of having a PE to diagnose and treat it quickly in order to reduce morbidity and mortality. Treatment involves hemodynamic and respiratory support, initial anticoagulation with drugs like heparin, and potentially reperfusion therapies for more severe cases including thrombolysis or embolectomy.
1. Pulmonary embolism is an obstruction of the pulmonary artery or its branches by a thrombus originating in the venous system or right side of the heart.
2. The annual incidence of PE ranges from 23-69 cases per 100,000 population in India. Globally, the incidence of venous thromboembolism remains relatively constant at 117 cases per 100,000 person-years.
3. Diagnosis involves using criteria like Wells criteria and PERC rule to determine pre-test probability, D-dimer testing, and imaging like CT pulmonary angiography or lung scan if needed based on risk level and test results. Management involves anticoagulation with heparin or low molecular weight he
This document discusses acute pulmonary embolism (PE), which results from blood clots (deep vein thromboses or DVTs) breaking off and traveling to the lungs. PE is a leading cause of preventable hospital death. The document covers risk factors for PE like immobility, surgery, cancer, and inherited conditions. It also discusses methods for diagnosing PE like the Wells criteria, D-dimer testing, chest imaging like CT scans, and treatment including anticoagulation and thrombolysis for hemodynamically unstable patients. Poor prognostic signs of PE include hypotension, cardiac biomarkers indicating injury, and imaging findings of right ventricular dysfunction. Prevention through appropriate DVT prophylaxis is emphasized.
This document discusses acute pulmonary embolism (PE), including its presentation, risk factors, diagnostic workup, and management. PE is a potentially life-threatening condition that is often missed or difficult to diagnose due to vague symptoms. Timely treatment is important as untreated PE has a 20-30% mortality rate. Diagnostic tests include D-dimer, CT pulmonary angiogram, ventilation-perfusion scan, and angiogram. Initial treatment involves anticoagulation with heparin or fondaparinux. Long-term anticoagulation with warfarin is recommended to prevent recurrence. Thrombolysis or embolectomy may be considered for massive PE with hemodynamic instability.
This document discusses pulmonary embolism (PE), including its definition, epidemiology, risk factors, pathophysiology, clinical features, diagnosis, and management. Some key points:
- PE is an obstruction of the pulmonary artery or its branches by a thrombus originating in the venous system or right heart. It is a common cause of preventable death in hospitalized patients.
- The annual incidence of PE ranges from 23-69 cases per 100,000 people in India. Worldwide, the incidence of venous thromboembolism (which includes PE and DVT) is 117 cases per 100,000 person-years.
- Risk factors for PE include hereditary clotting disorders, immobil
The document discusses acute pulmonary embolism (PE). PE is common but difficult to diagnose, with nonspecific symptoms. It describes a case of a 48-year-old woman presenting with sudden dyspnea, tachycardia, and leg swelling who may have PE. Risk factors for PE include recent surgery or trauma, prolonged immobilization, and inherited or acquired hypercoagulable states. Diagnosis involves clinical scoring, D-dimer, imaging like CTPA, and treatment includes anticoagulation with heparin or warfarin.
This document discusses pulmonary embolism (PE). It notes that PE is a common disorder that can be deadly if left untreated. The presentation of PE is often vague and nonspecific. While the classic triad of symptoms is hemoptysis, dyspnea, and pleuritic pain, this occurs in less than 20% of patients. The document reviews risk factors, clinical features, diagnostic testing options including Wells criteria, imaging studies, D-dimer testing and their limitations. Treatment involves anticoagulation with heparin or warfarin to prevent clot extension and recurrence while educating patients.
PowerPoint presentation about pulmonary embolism -- Teaching at Zagazig university cardiology department ,
Egypt in 2013 by Islam Ghanem , assistant lecturer of cardiology
Pulmonary embolism (PE) is a potentially life-threatening condition with an estimated incidence between 0.5-3% in the general population. Risk factors include previous DVT, immobilization, surgery, cancer, and certain genetic conditions. Symptoms are nonspecific but commonly include dyspnea, chest pain, and cough. Diagnostic tests include D-dimer, CT pulmonary angiogram (CTPA), ventilation-perfusion scan, and pulmonary angiogram. Clinical decision rules like Wells criteria are used to determine pre-test probability to guide appropriate testing. The diagnostic algorithm involves using Wells criteria and D-dimer to determine if CTPA is needed, with CTPA used to confirm or exclude the diagnosis in
A V/Q scan evaluates ventilation and perfusion of the lungs to diagnose pulmonary embolism (PE). It involves inhaling a radioactive gas to assess ventilation and receiving an IV injection of radioactive albumin to assess perfusion. Mismatched defects indicate PE while matched defects can indicate lung disease. The PIOPED study established criteria for classifying scans as high, intermediate, or low probability of PE. A normal scan makes PE unlikely while a high probability scan makes PE very likely. Other tests for PE include CT pulmonary angiogram, pulmonary angiogram, and chest x-ray.
This document discusses acute pulmonary embolism, including its causes, symptoms, diagnosis, and treatment. It notes that PE is a leading cause of preventable hospital death and that diagnosis can be difficult due to non-specific symptoms. The diagnosis involves a clinical probability assessment, d-dimer test, and CT scan. Treatment depends on risk stratification and may involve anticoagulation, thrombolysis for massive PE, or placement of an IVC filter. Prevention through prophylaxis in at-risk patients is emphasized.
This document summarizes pulmonary embolism (PE), including its epidemiology, risk factors, pathophysiology, clinical features, diagnostic testing, and treatment. PE is the second most common cause of unexpected death, with risk factors including recent surgery, trauma, cancer, and inherited or acquired thrombophilias. Diagnosis involves assessing clinical probability then confirming with D-dimer, imaging like CT pulmonary angiogram, or lung scintigraphy. For acute PE, initial treatment is heparin or fondaparinux followed by long-term oral anticoagulation to prevent recurrence. New oral anticoagulants targeting factor Xa provide alternatives to warfarin.
A pulmonary embolism occurs when a blood clot or other material occludes the pulmonary artery or its branches. This most commonly results from a deep vein thrombosis in the lower leg that embolizes to the lung. When a PE occurs, it causes ventilation-perfusion mismatching in the lungs. Diagnosis is difficult due to nonspecific symptoms but evaluation involves a Wells criteria assessment, D-dimer testing, echocardiogram, and CT pulmonary angiogram. Treatment consists of anticoagulation with low molecular weight heparin or novel oral anticoagulants. Fibrinolytic therapy may be used in massive PEs. Prevention focuses on prophylaxis in high risk hospitalized patients.
Pulmonary Embolism & Deep Vein Thrombosis - Handout.pdfAbdirizakJacda
This document provides an overview of a 60-minute webinar on pulmonary embolism (PE) and deep vein thrombosis (DVT). The webinar aims to cover the pathophysiology, risk factors, and management of PE and DVT according to NICE guidelines, and provide high-yield facts relevant for exams. The webinar will include a case-based discussion of a 65-year-old female presenting with shortness of breath and chest pain who has risk factors for PE. Slides and recordings from the webinar will be available on the listed website.
This document discusses MDCT and pulmonary embolism (PE). It provides an overview of risk factors for PE, clinical signs and symptoms, diagnostic tests including CXR, V/Q scan and pulmonary CTA. It describes techniques for optimal pulmonary CTA and discusses findings of acute vs chronic PE, as well as non-thrombotic causes of PE like tumor embolism. Common pitfalls in PE CTA are outlined.
Pulmonary embolism (PE) is a blockage in the lungs caused by blood clots that travel from deep veins, usually in the legs. It is the third most common cause of death in hospitalized patients, with over 650,000 cases occurring per year in the US. Risk factors include immobilization, hypercoagulability, and recent surgery or trauma. Symptoms can include chest pain, shortness of breath, cough, or fainting. Diagnosis is confirmed through imaging tests like CT angiography or ventilation-perfusion scans. Treatment involves blood thinners like heparin, warfarin, or newer oral anticoagulants to prevent further clotting. Thrombolytic drugs
Pneumonia is an infection of the lungs caused by bacteria, viruses or other pathogens. It is commonly transmitted when germs are inhaled into the lungs. Risk factors include impaired immunity, smoking, neurological conditions that impact swallowing, and chronic lung diseases. Diagnosis involves chest x-ray, sputum culture, blood tests and assessment of severity using CURB65 score. Treatment focuses on antibiotics, oxygen supplementation, hydration and symptom relief. Complications can include respiratory failure and sepsis.
Down syndrome is a genetic condition caused by trisomy of chromosome 21. It occurs in about 1 in 660 births. Key features in newborns include slanted eyes, small ears, loose skin on the back of the neck, and poor muscle tone. Individuals with Down syndrome often have health issues such as heart defects, hearing or vision problems, gastrointestinal abnormalities, thyroid disorders, and psychiatric conditions. Lifelong healthcare involves screening and management of associated medical problems with a focus on development, education, independence, and quality of life.
Diphtheria is an acute and highly contagious disease caused by Corynebacterium diphtheriae that causes inflammation of the mucous membranes and formation of a false membrane in the throat. It is usually spread through direct contact or contact with contaminated articles. Symptoms can range from mild to severe and include fever, sore throat, difficulty breathing and swallowing. Diphtheria is treated with antibiotics like penicillin or erythromycin and a diphtheria antitoxin for severe cases. Vaccination with Quinvaxem is recommended to protect children from the disease.
This document discusses the etiopathogenesis and management of preeclampsia. It begins by outlining recommendations for blood pressure measurement in pregnancy. It then covers the classification of hypertension in pregnancy and risk factors for preeclampsia. The document discusses the etiology of preeclampsia involving poor placentation leading to placental oxidative stress and endothelial dysfunction. Predictors of preeclampsia and the role of ultrasound are described. Management involves termination of pregnancy, with timing based on gestational age and severity of symptoms. Antihypertensive therapy aims to control blood pressure without dropping it too low.
This document discusses the management of preterm labor in cases of placenta previa and abruption placentae. It describes placenta previa as when the placenta is located over or near the internal os, and notes four degrees. For placenta previa, the expectant approach aims to continue the pregnancy for lung maturity using bed rest and monitoring. For abruption placentae, which is premature separation of a normally situated placenta, the active approach is indicated due to risks of further separation and fetal death, with immediate delivery by vaginal or cesarean delivery for severe cases.
Hypocalcemia occurs when serum calcium levels fall below 8.5 mg/dl. It can be caused by low or high parathyroid hormone levels. Low PTH levels are due to parathyroid agenesis, destruction, or reduced function. High PTH levels are caused by vitamin D deficiency, renal insufficiency, drugs, or miscellaneous conditions. Hypocalcemia symptoms vary based on severity and chronicity and include muscle spasms, paresthesia, and seizures. Treatment involves calcium and vitamin D supplementation.
Respiratory failure can occur due to hypoxemic failure, hypercapnic (ventilatory) failure, or impaired airway function. Noninvasive ventilation (NIV) delivers ventilatory support without an artificial airway and can effectively treat respiratory failure caused by conditions like COPD exacerbation and cardiogenic pulmonary edema. The first 30 minutes of NIV require intensive monitoring and support, but it can help improve gas exchange, respiratory effort, and outcomes when criteria for use are met and close monitoring of response is provided. NIV should be discontinued if the patient cannot tolerate the interface, respiratory status fails to improve, or intubation is needed.
Hyperkalemia is defined as a plasma potassium level above 5.5 mEq/L. It can be caused by a shift of potassium from intracellular to extracellular space due to acidosis or tissue damage. Other causes include reduced renal excretion due to medications like ACE inhibitors or renal failure. Symptoms range from none to muscle weakness to cardiac arrhythmias. Treatment involves calcium to antagonize cardiac effects, insulin or beta-agonists to shift potassium intracellularly, and cation exchange resins or dialysis to remove excess potassium.
The document provides an overview of asthma, including its history, symptoms, pathophysiology, diagnosis, and treatment. It defines asthma as a chronic inflammatory airway disease characterized by bronchial hyperresponsiveness. The symptoms of asthma include coughing, shortness of breath, wheezing, chest tightness, and inability to take in enough air. Diagnostic tests include peak flow testing, spirometry, allergy skin tests, and chest X-rays. Treatment involves education, avoidance of triggers, and medications like bronchodilators, corticosteroids, leukotriene antagonists, and mast cell stabilizers.
UnityNet World Environment Day Abraham Project 2024 Press ReleaseLHelferty
June 12, 2024 UnityNet International (#UNI) World Environment Day Abraham Project 2024 Press Release from Markham / Mississauga, Ontario in the, Greater Tkaronto Bioregion, Canada in the North American Great Lakes Watersheds of North America (Turtle Island).
Bienestar Financiero al servicio de su jubilación anticipada
Pago de su 🏡
Estudio de sus hijos
Directamente a tu cuenta bancaria
Con Tesorería Auditoria Jurídica comercial
Administración de carteras
Apalancamiento Financiero
Desarrollo de tu marca personal
Acceso a Desarrollo de varias industrias
Cuentas bancarias
Estructuras Físicas en USA y en América Central
Avalado por Bolcomer
Puesto de Bolsa Comercial
Turismo
Y mucho más
Link de registro
https://business.myinfinity.global/maurod8/
https://therusnetwork.com/
Contacto:
https://goo.su/pzm1fja
5. Patient with suspect symptomatic
Acute lower extremity DVT
Venous duplex scan negative Low clinical probability observe
High clinical probability
Repeat scan /
Venography
negative
positive
Evaluate coagulogram /thrombophilia/ malignancy
Anticoagulant therapy
contraindication
yes IVC filter
No
pregnancy LMWH
OPD LMWH
hospitalisation UFH
+ warfarin
Compression treatment
6. Thrombophilia screening
Factor V leiden, Prot C/S deficiency
Antithrombin III deficiency
Idiopathic DVT < 50 years
Family history of DVT
Thrombosis in an unusual site
Recurrent DVT
7. Recommendation for
duration of warfarin
3-6 months first DVT with reversible
risk factors
At least 6 months for first idiopathic
DVT
12 months to lifelong for recurrent DVT
or first DVT with irreversible risk factors
malignancy or thrombophilic state
10. 10
50,000 individuals die from PE each
year in USA
The incidence of PE in USA is 500,000
per year
11. 11
Incidence of Pulmonary Embolism Per Year in the United States*
Total Incidence
630,000
Death within 1 hr
67,000
11%
Survival >1hr
563,000
89%
Dx not made
400,000
71%
Dx made, therapy
instituted 163,000
29%
Survival
280,000
70%
Death
120,000
30%
Survival
150,000
Death
120,000
92% 8%
*Progress in Cardiovascular
Diseases, Vol. XVII, No. 4
(Jan/Feb 1975)
12. 12
Risk factor for venous
thrombosis
Stasis
Injury to venous intima
Alterations in the coagulation-fibrinolytic
system
13. 13
Source of emboli
Deep venous thrombosis (>95%)
Other veins:
Renal
Uterine
Right cardiac chambers
14. 14
Risk factors for DVT
General anesthesia
Lower limb or pelvic injury or surgery
Congestive heart failure
Prolonged immobility
Pregnancy
Postpartum
Oral contraceptive pills
Malignancy
Obesity
Advanced age
Coagulation problems
15. 15
Clinical features
Sudden onset dyspnea
Pleuritic chest pain
Hemoptysis
Clinical clues cannot make the diagnosis
of PE; their main value lies in
suggesting the diagnosis
16. 16
Signs or symptoms observed in patients with thromboembolism
Study
Stein et al., %
(n= 117)
Anderson et
al., % (n= 131)
Pulmonary
embolism
Dyspnea 73 77
Tachypnea 70 70
Chest pain 66 55
Cough 37 —
Tachycardia 30 43
Cyanosis 1 18
Hemoptysis 13 13
Wheezing 9 —
Hypotension — 10
17. 17
Signs or symptoms observed in patients with thromboembolism
Study
Stein et al., %
(n= 117)
Anderson et
al., % (n= 131)
Pulmonary
Embolism
Syncope — 10
Elevated jugular
venous pulse
— 8
Temperature
>38.5°C
7 —
S-3 gallop 3 5
Pleural friction
rub
3 2
18. 18
Signs or symptoms observed in patients with thromboembolism
Study
Stein et al., %
(n= 117)
Anderson et
al., % (n= 131)
Deep vein
thrombosis
Swelling 28 88*
Pain 26 56
Tenderness — 55
Warmth — 42
Redness — 34
Homan’s sign 4 13
Palpable cord — 6
19. 19
Massive Pulmonary
Embolism
It is a catastrophic entity which often results
in acute right ventricular failure and death
Frequently undiscovered until autopsy
Fatal PE typically leads to death within one to
two hours of the event
20. 20
Pathophysiology
Massive PE causes an increase in PVR right
ventricular outflow obstruction decrease left
ventricular preload Decrease CO
In patients without cardiopulmonary disease,
occlusion of 25-30 % of the vascular bed
increase in Pulmonary artery pressure (PAP)
Hypoxemia ensues stimulating vasoconstriction
increase in PAP
21. 21
Pathophysiology
More than 50% of the vascular bed has to be
occluded before PAP becomes substantially elevated
When obstruction approaches 75%, the RV must
generate systolic pressure in excess of 50mmHg to
preserve pulmonary circulation
The normal RV is unable to accomplish this acutely
and eventually fails
27. 27
Diagnosis
The diagnosis of massive PE should be explored
whenever oxygenation or hemodynamic parameters
are severely compromised without explanation
CXR
ABG:
Significant hypoxemia is almost uniformly present when
there is a hemodynamically significant PE
V/Q
Spiral CT
Echo
Angio
36. 36
The use of ventilation perfusion scan in diagnosing pulmonary
embolism
High probability
=2 large segmental (>75% of a segment) perfusion defects without
corresponding ventilation or radiographic abnormalities or substantially larger
than matching ventilation or radiologic abnormalities
OR
=2 moderate segmental (>25% and <75% of a segment) perfusion defects
without matching ventilation or chest radiographic abnormalities plus one
large unmatched segmental defect
OR
=4 moderate segmental perfusion defects without matching ventilation or
chest radiologic abnormalities
37. 37
The use of ventilation perfusion scan in diagnosing pulmonary
embolism
Intermediate probability
Scans that do not fall into normal, very low, low, or high probability categories
38. 38
The use of ventilation perfusion scan in diagnosing pulmonary
embolism
Low probability
Nonsegmental perfusion defects
OR
Single moderate mismatched segmental perfusion defect with normal chest
radiograph
OR
Any perfusion defect with a substantially larger abnormality on chest
radiograph
OR
Large or moderate segmental perfusion defects involving no more than four
segments in one lung and no more than three segments in one lung region
with matching or larger ventilation/radiographic abnormalities
OR
More than three small segmental perfusion defects (<25% of a segment) with
a normal chest radiograph
39. 39
The use of ventilation perfusion scan in diagnosing pulmonary
embolism
Very low probability
Three or fewer small segmental perfusion defects with a normal chest
radiograph
Normal
No perfusion defects present
43. 43
Prospective Investigation of Pulmonary
Embolism Diagnosis (PIOPED) results
Prospective investigation of pulmonary embolism diagnosis results
Scan
category
PE present PE absent PE
uncertain
No
angiogram
Total
High
probability
102 14 1 7 124
Intermediate
probability
105 217 9 33 364
Low
probability
39 199 12 62 312
Near normal
or normal
5 50 2 74 131
Total 251 480 24 176 931
54. 54
Dosage and monitoring of anticoagulant
therapy
Dosage and monitoring of anticoagulant therapy
After initiating heparin therapy, repeat APTT every 6 h for first 24 h and then
every 24 h when therapeutic APTT is achieved
Warfarin 5 mg/d can be started on day 1 of therapy; there is no benefit from
higher starting doses
Platelet count should be monitored at least every 3 d during initial heparin
therapy
Therapeutic APTT should correspond to plasma heparin level of 0.2–0.4
IU/mL
Heparin is usually continued for 5–7 d
Heparin can be stopped after 4–5 d of warfarin therapy when INR is in 2.0–
3.0 range
55. 55
Important drug interactions with warfarin
Drugs that decrease warfarin
requirement
Drugs that increase warfarin
requirement
Phenylbutazone Barbiturates
Metronidazole Carbamazepine
Trimethoprim-sulfamethoxazole Rifampin
Amiodarone Penicillin
Second- and third-generation
cephalosporins
Griseofulvin
Clofibrate Cholestyramine
Erythromycin
Anabolic steroids
Thyroxine
56. 56
Complications of anticoagulation
Complication Management
Heparin Bleeding Stop heparin infusion.
For severe bleeding,
the anticoagulant
effect of heparin can
be reversed with
intravenous protamine
sulfate 1 mg/100 units
of heparin bolus or 0.5
mg for the number of
units given by constant
infusion over the past
hour; provide
supportive care
including transfusion
and clot evacuation
from closed body
cavities as needed.
57. 57
Complications of anticoagulation
Complication Management
Heparin Heparin-induced
thrombocytopenia and
thrombosis
Carefully monitor
platelet count during
therapy. Stop-heparin
for platelet counts
<75,000. Replace
heparin with direct
inhibitors of thrombin-
like desirudin if
necessary. These
agents do not cause
heparin-induced
thrombocytopenia.
Avoid platelet
transfusion because of
the risk for thrombosis.
58. 58
Complications of anticoagulation
Complication Management
Heparin Heparin-induced
osteoporosis (therapy
>1 mo)
LMWHs may have
lower propensity to
cause osteoporosis as
compared with
unfractionated heparin;
consider LMWH if
prolonged heparin
therapy is necessary.
59. 59
Complications of anticoagulation
Complication Management
Warfarin Bleeding Stop therapy. Administer
vitamin K and fresh-
frozen plasma for severe
bleeding; provide
supportive care including
transfusion and clot
evacuation from closed
body cavities as needed
Skin necrosis (rare) Supportive care.
Teratogenicity Do not use in pregnancy
or in patients planning to
become pregnant.
60. 60
Risks and benefits of thrombolytics vs heparin therapy for
pulmonary embolism
Thrombolytic
therapy
No difference Heparin
Improved resolution at 2-4 h after onset of therapy
Angiography + - -
Pulmonary artery
pressure
+ - -
Echocardiography
+ - -
Resolution at 24 h
Lung scan + - -
Angiography + - -
61. 61
Risks and benefits of thrombolytics vs heparin therapy for
pulmonary embolism
Thrombolytic
therapy
No difference Heparin
Echocardiograp
hy
+ - -
Pulmonary
artery pressure
+ - -
Resolution at 1
wk and 30 d
(lung scan)
- + -
Rate of
confirmed
recurrent
pulmonary
embolism
- + -
62. 62
Risks and benefits of thrombolytics vs heparin therapy for
pulmonary embolism
Thrombolytic
therapy
No difference Heparin
Hospital
mortality
- + -
Late mortality - + -
Less severe
bleeding
- - +
Less intracranial
hemorrhage
- - +
Lower cost - - +
63. 63
Approved thrombolytics for pulmonary embolism
Approved thrombolytics for pulmonary embolism
Streptokinase
250,000 IU as loading dose over 30 min, followed by
100,000 U/h for 24 h
Urokinase
4400 IU/kg as a loading dose over 10 min, followed
by 4400 IU/kg/h for 12-24 h
Recombinant tissue-plasminogen activator
100 mg as a continuous peripheral intravenous
infusion administered over 2 h
64. 64
Indications and contraindications for thrombolytic
therapy in pulmonary embolism
Indications
Hemodynamic instability
Hypoxia on 100% oxygen
Right ventricular dysfunction by echocardiography
65. 65
Contraindications
Relative
Recent surgery within last 10 d Previous arterial punctures within 10 d
Neurosurgery within 6 mo Bleeding disorder (thrombocytopenia, renal failure, liver
failure)
Ophthalmologic surgery within 6 wk
Hypertension >200 mm Hg systolic or 110 mm Hg diastolic Placement of central venous
catheter within 48 h
Hypertensive retinopathy with hemorrhages or exudates Intracerebral aneurysm or
malignancy
Cardiopulmonary resuscitation within 2 wk
Cerebrovascular disease
Major internal bleeding within the last 6 mo Pregnancy and the 1st 10 d postpartum
Infectious endocarditis Severe trauma within 2 mo
Pericarditis
Absolute
Active internal bleeding
67. Indications for inferior vena caval (IVC) filters
Absolute contraindication to anticoagulation
(eg, active bleeding)
Recurrent PE despite adequate anticoagulant
therapy
Complication of anticoagulation (eg, severe
bleeding)
Hemodynamic or respiratory compromise that
is severe enough that another PE may be
lethal
67
68. EMBOLECTOMY
Embolectomy (ie, removal of the emboli) can
be performed using catheters or surgically.
It should be considered when a patient's
presentation is severe enough to warrant
thrombolysis (eg, persistent hypotension due
to PE), but this approach either fails or is
contraindicated.
68
69. 69
Conclusions
PE is common and under-recognized
serious medical problem
Early diagnosis and treatment is
essential for good outcome
High index of suspicion is needed in
high risk patients