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PULMONARY EMBOLISM
SIGN & SYMPTOM [THEORY] Symptoms  Signs Dyspnea(73%) Pleuritic chest pain(66%)  Cough(37%) Hemoptysis(13%)  Tachypnea(70%) Rales(51%) Tachycardia(30%)  Fourth heart sound(24%)  Accentuated pulmonic component of the second  heart sound(23%) seizures, syncope, abdominal pain, fever, productive cough, wheezing, decreasing level of consciousness, new onset of atrial fibrillation fever(14%)< 39?c>, chest wall tenderness
DDx. ,[object Object],[object Object],[object Object]
INVESTIGATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CXR  Initial CxR always  NORMAL May show – Collapse, consolidation, small pleural effusion, elevated diaphragm.
EKG
PULMONARY ANGIOGRAPHY
CT SCAN
PERFUSION SCAN Perfusion Mismatch Ventilation
แนวทางการประเมินผู้ป่วย
INVESTIGATE OF Pt. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DEFINITE DX. ,[object Object]
CAUSES ,[object Object]
RISK FACTOR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PICTURE OF BLOOD CLOT IS FORMED
 
INDICATION FOR ADMISSION ,[object Object],[object Object],[object Object],[object Object]
TREATMENT [Theory] ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
การแบ่งประเภท  &  การรักษา Syndrome Rt. ventricular  dysfunction อาการนำ การรักษา Massive Breathlessnesssyncope cyanosis Hypotension   การอุดตัน  >50 % มี Heparin   ร่วมกับ thrombolytic therapy  หรือ  mechanical intervention Moderate  ถึง   large pulmonary infarction  ความดันโลหิตปกติ Perfusion decrease >30%  มี Heparin+-thormbolytic therapy or mechanical intervention
การแบ่งประเภท  &  การรักษา Syndrome Rt. ventricular  dysfunction อาการนำ การรักษา small  ถึง   moderate pulmonary infarction  ความดันโลหิตปกติ Pleuritic chest pain, hemoptysis, pleural rub or lung consolidation;  peripheral  emboli  ไม่มี / พบน้อย Heparin Heparin & NSAIDs
การแบ่งประเภท  &  การรักษา Syndrome Rt. ventricular  dysfunction อาการนำ การรักษา Paradoxical embolism Sudden systemic emboli event such as  stroke พบน้อย Anticoagulant +closure of right-to-left cardiac Nonthrombotic embolism ส่วนใหญ่เป็น  air, fat, tumor   fragments   หรือ  amniotic fluid พบน้อย รักษาแบบประคับประคอง
สรุปแนวทางการรักษาภาวะ  ACUTE PULMONARY EMBOLISM
IVC FILTER If anticoagulant therapy is  contraindicated  and / or ineffective
TREATMENT [Pt.] ,[object Object],[object Object],[object Object]
LOS ,[object Object],[object Object],[object Object],[object Object]

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Pulmonary Embolism

  • 2. SIGN & SYMPTOM [THEORY] Symptoms Signs Dyspnea(73%) Pleuritic chest pain(66%) Cough(37%) Hemoptysis(13%) Tachypnea(70%) Rales(51%) Tachycardia(30%) Fourth heart sound(24%) Accentuated pulmonic component of the second heart sound(23%) seizures, syncope, abdominal pain, fever, productive cough, wheezing, decreasing level of consciousness, new onset of atrial fibrillation fever(14%)< 39?c>, chest wall tenderness
  • 3.
  • 4.
  • 5. CXR Initial CxR always NORMAL May show – Collapse, consolidation, small pleural effusion, elevated diaphragm.
  • 6. EKG
  • 9. PERFUSION SCAN Perfusion Mismatch Ventilation
  • 11.
  • 12.
  • 13.
  • 14.
  • 15. PICTURE OF BLOOD CLOT IS FORMED
  • 16.  
  • 17.
  • 18.
  • 19. การแบ่งประเภท & การรักษา Syndrome Rt. ventricular dysfunction อาการนำ การรักษา Massive Breathlessnesssyncope cyanosis Hypotension การอุดตัน >50 % มี Heparin ร่วมกับ thrombolytic therapy หรือ mechanical intervention Moderate ถึง large pulmonary infarction ความดันโลหิตปกติ Perfusion decrease >30% มี Heparin+-thormbolytic therapy or mechanical intervention
  • 20. การแบ่งประเภท & การรักษา Syndrome Rt. ventricular dysfunction อาการนำ การรักษา small ถึง moderate pulmonary infarction ความดันโลหิตปกติ Pleuritic chest pain, hemoptysis, pleural rub or lung consolidation; peripheral emboli ไม่มี / พบน้อย Heparin Heparin & NSAIDs
  • 21. การแบ่งประเภท & การรักษา Syndrome Rt. ventricular dysfunction อาการนำ การรักษา Paradoxical embolism Sudden systemic emboli event such as stroke พบน้อย Anticoagulant +closure of right-to-left cardiac Nonthrombotic embolism ส่วนใหญ่เป็น air, fat, tumor fragments หรือ amniotic fluid พบน้อย รักษาแบบประคับประคอง
  • 23. IVC FILTER If anticoagulant therapy is contraindicated and / or ineffective
  • 24.
  • 25.