1) Pulmonary embolism (PE) was first described in the 18th century and risk factors include both modifiable factors like obesity and smoking as well as non-modifiable factors like age, family history, and cancer.
2) PE is classified by size from massive to small, with massive PE affecting half the pulmonary arteries and causing shock while small PE causes few symptoms.
3) Diagnosis involves assessment of clinical probability with tools like Wells Criteria followed by tests like CT, ventilation-perfusion scan, or ultrasound depending on the patient's situation.
4) Treatment involves anticoagulation with drugs like heparin or novel oral anticoagulants, with duration depending on prov
The document discusses various diseases of the aorta including aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, aortic aneurysm, atherosclerotic disease, coarctation, and aortic trauma. It provides an overview of the anatomy, clinical presentation, diagnostic imaging, complications, and treatment options for each condition. Key imaging modalities for diagnosis include transthoracic echocardiography, transesophageal echocardiography, CT, and MRI. Mortality rates and predictors of outcome are also reviewed.
Pulmonary embolism (PE) is a common clinical disorder associated with high morbidity and mortality. PE occurs when deep vein thrombi detach and embolize to the pulmonary circulation, obstructing blood flow and impairing gas exchange. Clinical presentation of PE is variable but often includes dyspnea, tachypnea, tachycardia, and pleuritic chest pain. Diagnosis involves assessment of clinical probability, d-dimer testing, imaging studies like CT pulmonary angiography, ventilation-perfusion scanning, echocardiography and assessment of right ventricular function. Prompt diagnosis and treatment are important to prevent complications including right heart failure and death.
Presentation1.pptx, radiological imaging of pulmonary embolism.Abdellah Nazeer
This document discusses pulmonary embolism (PE), which occurs when a blood clot or other substance blocks a pulmonary artery in the lungs. PE is commonly caused by deep vein thrombosis. The document outlines common symptoms of PE and risk factors. It then describes various radiological imaging techniques used to diagnose PE, including chest X-rays, CT scans, ultrasound, V/Q scans, pulmonary angiograms, and MRI. The document discusses diagnostic criteria for PE on CT imaging and provides examples of images showing acute and chronic PE. It also covers D-dimer testing and describes the appearance of massive, saddle, and bilateral PE on CT scans.
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 Hypertension: Clinical diagnosis, hemodynamics and approach - Dr. A...akifab93
This document discusses pulmonary hypertension (PH), including its definition, pathophysiology, causes, signs and symptoms, diagnostic evaluation, and radiographic findings. PH is defined as a mean pulmonary arterial pressure over 25 mmHg at rest as assessed by right heart catheterization. The pathophysiology involves pulmonary vasoconstriction, endothelial dysfunction, vascular remodeling, and an imbalance of various mediators. PH can be caused by left heart disease, lung diseases, chronic thromboembolic disease, or other rare diseases. Common signs include dyspnea, fatigue, edema, and right heart failure. Diagnostic tests include echocardiogram, CT, ventilation/perfusion scan, right heart catheterization. Chest x-ray may show
- 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 provides a guide on abdominal aortic aneurysms (AAAs) for medical students. It defines AAAs as abnormal dilatations of the aorta between the diaphragm and iliac arteries. AAAs are usually asymptomatic but can rupture, causing severe abdominal pain and shock. Risk factors include smoking, male sex, age, and family history. Ultrasound is used to detect AAAs by measuring diameter. Larger AAAs have higher rupture risks and may require elective open or endovascular repair surgery to prevent rupture. Complications after endovascular repair include endoleaks, where blood bypasses the graft. Ruptured AAAs require emergency open repair surgery.
1) Pulmonary embolism (PE) was first described in the 18th century and risk factors include both modifiable factors like obesity and smoking as well as non-modifiable factors like age, family history, and cancer.
2) PE is classified by size from massive to small, with massive PE affecting half the pulmonary arteries and causing shock while small PE causes few symptoms.
3) Diagnosis involves assessment of clinical probability with tools like Wells Criteria followed by tests like CT, ventilation-perfusion scan, or ultrasound depending on the patient's situation.
4) Treatment involves anticoagulation with drugs like heparin or novel oral anticoagulants, with duration depending on prov
The document discusses various diseases of the aorta including aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, aortic aneurysm, atherosclerotic disease, coarctation, and aortic trauma. It provides an overview of the anatomy, clinical presentation, diagnostic imaging, complications, and treatment options for each condition. Key imaging modalities for diagnosis include transthoracic echocardiography, transesophageal echocardiography, CT, and MRI. Mortality rates and predictors of outcome are also reviewed.
Pulmonary embolism (PE) is a common clinical disorder associated with high morbidity and mortality. PE occurs when deep vein thrombi detach and embolize to the pulmonary circulation, obstructing blood flow and impairing gas exchange. Clinical presentation of PE is variable but often includes dyspnea, tachypnea, tachycardia, and pleuritic chest pain. Diagnosis involves assessment of clinical probability, d-dimer testing, imaging studies like CT pulmonary angiography, ventilation-perfusion scanning, echocardiography and assessment of right ventricular function. Prompt diagnosis and treatment are important to prevent complications including right heart failure and death.
Presentation1.pptx, radiological imaging of pulmonary embolism.Abdellah Nazeer
This document discusses pulmonary embolism (PE), which occurs when a blood clot or other substance blocks a pulmonary artery in the lungs. PE is commonly caused by deep vein thrombosis. The document outlines common symptoms of PE and risk factors. It then describes various radiological imaging techniques used to diagnose PE, including chest X-rays, CT scans, ultrasound, V/Q scans, pulmonary angiograms, and MRI. The document discusses diagnostic criteria for PE on CT imaging and provides examples of images showing acute and chronic PE. It also covers D-dimer testing and describes the appearance of massive, saddle, and bilateral PE on CT scans.
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 Hypertension: Clinical diagnosis, hemodynamics and approach - Dr. A...akifab93
This document discusses pulmonary hypertension (PH), including its definition, pathophysiology, causes, signs and symptoms, diagnostic evaluation, and radiographic findings. PH is defined as a mean pulmonary arterial pressure over 25 mmHg at rest as assessed by right heart catheterization. The pathophysiology involves pulmonary vasoconstriction, endothelial dysfunction, vascular remodeling, and an imbalance of various mediators. PH can be caused by left heart disease, lung diseases, chronic thromboembolic disease, or other rare diseases. Common signs include dyspnea, fatigue, edema, and right heart failure. Diagnostic tests include echocardiogram, CT, ventilation/perfusion scan, right heart catheterization. Chest x-ray may show
- 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 provides a guide on abdominal aortic aneurysms (AAAs) for medical students. It defines AAAs as abnormal dilatations of the aorta between the diaphragm and iliac arteries. AAAs are usually asymptomatic but can rupture, causing severe abdominal pain and shock. Risk factors include smoking, male sex, age, and family history. Ultrasound is used to detect AAAs by measuring diameter. Larger AAAs have higher rupture risks and may require elective open or endovascular repair surgery to prevent rupture. Complications after endovascular repair include endoleaks, where blood bypasses the graft. Ruptured AAAs require emergency open repair surgery.
Pulmonary embolism occurs when a blood clot blocks an artery in the lungs, usually originating from deep vein thrombosis. Symptoms range from sudden shortness of breath to chest pain. Diagnosis involves tests like CT scans, V/Q scans, echocardiograms and blood tests. Treatment consists of oxygen, anticoagulant drugs, and sometimes fibrinolytics for massive clots. Long term prevention focuses on continued anticoagulation and devices like IVC filters for recurrent embolisms despite treatment.
A pulmonary embolism occurs when a blood clot forms in the deep veins of the legs or pelvis and travels through the bloodstream, lodging in the pulmonary arteries of the lungs. It can be difficult to diagnose and is a potentially life-threatening condition. Diagnostic tests may include a d-dimer blood test, CT scan, ventilation-perfusion scan, echocardiogram, and angiogram. Treatment involves anticoagulation medications to prevent further clotting and thrombolysis in some severe cases. Prevention by minimizing risk factors for deep vein thrombosis is important.
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.
Pulmonary Artery Anatomy and Pulmonary EmbolismGamal Agmy
The document describes the anatomy of the pulmonary arteries, including their branching patterns and variations. It begins with an overview of the main pulmonary artery and its bifurcation. It then details the typical anatomy and variations seen in the arteries of the right upper lobe, middle lobe, right lower lobe, left upper lobe, and left lower lobe. Key branches are named according to accepted anatomical conventions. Variations that occur in 10-30% of individuals are highlighted.
An aortic aneurysm is a localized sac or dilation formed at a weak point in the aortic wall. They most commonly occur in the abdominal aorta and can be caused by conditions like hypertension, atherosclerosis, and smoking. Aortic aneurysms are classified as either saccular or fusiform based on their shape and size. Untreated aneurysms risk rupture, which can cause massive hemorrhage and death. Surgical treatment involves replacing the diseased aortic segment with a synthetic graft to prevent rupture.
Cardiomegaly is a condition where the heart is enlarged. It can be caused by conditions that make the heart work harder like high blood pressure, heart disease, or heart valve problems. Symptoms include shortness of breath, fatigue, chest pain, and swelling. Diagnosis involves tests like chest x-rays, echocardiograms, and blood tests. Treatment may include medications to reduce blood pressure and swelling, surgery, lifestyle changes, and sometimes a heart transplant for severe cases.
This document discusses pulmonary thromboembolism (PE), which occurs when a blood clot blocks the pulmonary artery or its branches in the lungs. PE is usually caused by deep vein thrombosis, where a clot breaks off and travels to the lungs. Symptoms include dyspnea, chest pain, and coughing. Risk factors include prolonged immobilization, recent surgery or trauma, oral contraceptive use, pregnancy, and inherited or acquired hypercoagulable states. Diagnosis involves chest x-ray, ventilation-perfusion scanning, and pulmonary angiography to detect clots in the pulmonary arteries.
This document discusses pulmonary embolism (PE). Some key points:
- PE causes 50,000-200,000 deaths annually in the US, with an incidence of 500,000 cases.
- Risk factors include stasis, injury to veins, and coagulation issues.
- PE occurs when clots, usually from deep leg veins, travel to the lungs and block vessels. This can strain the right ventricle.
- Symptoms include sudden dyspnea, tachycardia, chest pain, hemoptysis. No single symptom confirms PE.
- Diagnosis involves CXR, blood tests, V/Q scan, CT, and angiogram. ECG may show right
This document discusses pneumothorax, which is an abnormal collection of air in the pleural space. A pneumothorax can occur when the negative pressure that normally exists in the pleural space is lost, allowing the lung to collapse. Symptoms include chest pain and dyspnea. Different types of pneumothorax are discussed, as well as causes, diagnostic tools, and treatment approaches which may include observation, needle aspiration, chest tube placement, or surgery depending on the size and severity in each case. Recurrent pneumothorax may warrant surgical pleurectomy or chemical pleurodesis to prevent future occurrences.
Dr. Sagar Gandhi discusses pneumothorax in this document. Pneumothorax is defined as air in the pleural space between the lungs and chest wall. It can be primary or secondary and spontaneous or traumatic. Diagnosis is made through chest x-ray or CT scan. Treatment depends on size and includes observation, oxygen therapy, needle aspiration, catheter drainage, or chest tube placement. The goal is to promote lung re-expansion and prevent recurrence.
The document discusses right ventricular failure (RVF) after cardiac surgery. It begins by outlining risk factors and the dynamics that lead to RVF. It describes how to assess the severity of RVF using laboratory, hemodynamic, and echocardiographic data. The document concludes by discussing the management of RVF in postsurgical patients, which involves optimizing volume status, rhythm control, afterload reduction, RV perfusion, contractility, and the potential use of mechanical support devices if needed.
Pulmonary embolism (PE) refers to obstruction of the pulmonary artery or its branches, usually by blood clots originating from the deep veins of the lower extremities. PE is a common and potentially lethal condition, with many patients dying within hours of onset from blockage of blood flow to the lungs. The diagnosis of PE involves evaluating risk factors, performing physical exams, blood tests like D-dimer, and imaging tests like CT pulmonary angiography or ventilation-perfusion scans. Effective treatment requires identifying patients at high risk of complications or death.
This document provides information on imaging of aortic dissection, including:
1. CT is the most sensitive imaging method for detecting aortic dissection, showing features like an intimal flap separating the true and false lumens.
2. Risk factors include hypertension, male sex, advanced age, and connective tissue disorders. Acute aortic dissections are classified as Stanford type A or B.
3. Management decisions are based on details of the dissection like entry/exit points and branch vessel involvement that affect outcomes.
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
Trans-esophageal echocardiography (TEE) uses ultrasound to obtain high-quality images of the heart and surrounding structures. It involves inserting a probe with an ultrasound transducer at the tip through the mouth and esophagus. TEE provides clearer images than transthoracic echocardiography as the esophagus is directly behind the heart. A TEE exam involves systematically imaging the heart in various planes as the transducer is advanced and manipulated. Standard views include the mid-esophageal four-chamber, two-chamber, aortic, and RV inflow-outflow views. Real-time 3D TEE can provide en face views of structures.
The document discusses aortic regurgitation, including its anatomy, etiology, pathophysiology, epidemiology, clinical manifestations, diagnosis, and management. Key points include:
- Aortic regurgitation occurs when the aortic valve fails to close properly, allowing blood to flow back into the left ventricle during diastole.
- Causes include conditions like infective endocarditis, bicuspid aortic valve, hypertension, and Marfan syndrome.
- In acute severe cases, a rapid increase in left ventricular preload can cause pulmonary edema and cardiogenic shock. Chronic cases involve left ventricular dilation and hypertrophy to compensate for the increased preload over time.
- Physical exam may
The document discusses constrictive pericarditis, providing details on:
1) The pathology of constrictive pericarditis which involves thickening and scarring of the pericardium leading to loss of elasticity.
2) The pathophysiology of constrictive pericarditis where the inelastic pericardium constrains cardiac filling and prevents adaptation to volume changes.
3) Key diagnostic features of constrictive pericarditis seen on echocardiogram include septal bounce, rapid early diastolic mitral inflow, and increased mitral annular velocities that rise with inspiration.
Pulmonary Embolism- Diagnosis by Dr.Tinku JosephDr.Tinku Joseph
This document discusses diagnostic tests for pulmonary embolism (PE). It describes various imaging studies including chest x-rays, V/Q scans, CT scans, pulmonary angiograms, and echocardiograms. It also discusses laboratory tests like D-dimer, troponin, and BNP levels. CT pulmonary angiography is becoming the initial test of choice due to its speed and ability to directly visualize PEs. V/Q scans remain useful in pregnant patients due to their lower radiation exposure compared to CT scans. No single test is perfect, so a combination of clinical assessment, imaging, and lab tests is usually needed to diagnose PE.
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
This document provides an overview of pulmonary embolism (PE), including its definition, risk factors, types, natural history, symptoms, signs, investigations, diagnosis, and management. PE is defined as obstruction of the pulmonary artery or its branches by material such as thrombus. It discusses diagnostic tests like CT, VQ scan, echocardiogram and their role in determining pretest probability. Management involves anticoagulation with drugs like heparin, warfarin, rivaroxaban. Thrombolysis may be used for massive PE while inferior vena cava filters can be placed in patients who cannot receive anticoagulation.
Pulmonary embolism occurs when a blood clot blocks an artery in the lungs, usually originating from deep vein thrombosis. Symptoms range from sudden shortness of breath to chest pain. Diagnosis involves tests like CT scans, V/Q scans, echocardiograms and blood tests. Treatment consists of oxygen, anticoagulant drugs, and sometimes fibrinolytics for massive clots. Long term prevention focuses on continued anticoagulation and devices like IVC filters for recurrent embolisms despite treatment.
A pulmonary embolism occurs when a blood clot forms in the deep veins of the legs or pelvis and travels through the bloodstream, lodging in the pulmonary arteries of the lungs. It can be difficult to diagnose and is a potentially life-threatening condition. Diagnostic tests may include a d-dimer blood test, CT scan, ventilation-perfusion scan, echocardiogram, and angiogram. Treatment involves anticoagulation medications to prevent further clotting and thrombolysis in some severe cases. Prevention by minimizing risk factors for deep vein thrombosis is important.
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.
Pulmonary Artery Anatomy and Pulmonary EmbolismGamal Agmy
The document describes the anatomy of the pulmonary arteries, including their branching patterns and variations. It begins with an overview of the main pulmonary artery and its bifurcation. It then details the typical anatomy and variations seen in the arteries of the right upper lobe, middle lobe, right lower lobe, left upper lobe, and left lower lobe. Key branches are named according to accepted anatomical conventions. Variations that occur in 10-30% of individuals are highlighted.
An aortic aneurysm is a localized sac or dilation formed at a weak point in the aortic wall. They most commonly occur in the abdominal aorta and can be caused by conditions like hypertension, atherosclerosis, and smoking. Aortic aneurysms are classified as either saccular or fusiform based on their shape and size. Untreated aneurysms risk rupture, which can cause massive hemorrhage and death. Surgical treatment involves replacing the diseased aortic segment with a synthetic graft to prevent rupture.
Cardiomegaly is a condition where the heart is enlarged. It can be caused by conditions that make the heart work harder like high blood pressure, heart disease, or heart valve problems. Symptoms include shortness of breath, fatigue, chest pain, and swelling. Diagnosis involves tests like chest x-rays, echocardiograms, and blood tests. Treatment may include medications to reduce blood pressure and swelling, surgery, lifestyle changes, and sometimes a heart transplant for severe cases.
This document discusses pulmonary thromboembolism (PE), which occurs when a blood clot blocks the pulmonary artery or its branches in the lungs. PE is usually caused by deep vein thrombosis, where a clot breaks off and travels to the lungs. Symptoms include dyspnea, chest pain, and coughing. Risk factors include prolonged immobilization, recent surgery or trauma, oral contraceptive use, pregnancy, and inherited or acquired hypercoagulable states. Diagnosis involves chest x-ray, ventilation-perfusion scanning, and pulmonary angiography to detect clots in the pulmonary arteries.
This document discusses pulmonary embolism (PE). Some key points:
- PE causes 50,000-200,000 deaths annually in the US, with an incidence of 500,000 cases.
- Risk factors include stasis, injury to veins, and coagulation issues.
- PE occurs when clots, usually from deep leg veins, travel to the lungs and block vessels. This can strain the right ventricle.
- Symptoms include sudden dyspnea, tachycardia, chest pain, hemoptysis. No single symptom confirms PE.
- Diagnosis involves CXR, blood tests, V/Q scan, CT, and angiogram. ECG may show right
This document discusses pneumothorax, which is an abnormal collection of air in the pleural space. A pneumothorax can occur when the negative pressure that normally exists in the pleural space is lost, allowing the lung to collapse. Symptoms include chest pain and dyspnea. Different types of pneumothorax are discussed, as well as causes, diagnostic tools, and treatment approaches which may include observation, needle aspiration, chest tube placement, or surgery depending on the size and severity in each case. Recurrent pneumothorax may warrant surgical pleurectomy or chemical pleurodesis to prevent future occurrences.
Dr. Sagar Gandhi discusses pneumothorax in this document. Pneumothorax is defined as air in the pleural space between the lungs and chest wall. It can be primary or secondary and spontaneous or traumatic. Diagnosis is made through chest x-ray or CT scan. Treatment depends on size and includes observation, oxygen therapy, needle aspiration, catheter drainage, or chest tube placement. The goal is to promote lung re-expansion and prevent recurrence.
The document discusses right ventricular failure (RVF) after cardiac surgery. It begins by outlining risk factors and the dynamics that lead to RVF. It describes how to assess the severity of RVF using laboratory, hemodynamic, and echocardiographic data. The document concludes by discussing the management of RVF in postsurgical patients, which involves optimizing volume status, rhythm control, afterload reduction, RV perfusion, contractility, and the potential use of mechanical support devices if needed.
Pulmonary embolism (PE) refers to obstruction of the pulmonary artery or its branches, usually by blood clots originating from the deep veins of the lower extremities. PE is a common and potentially lethal condition, with many patients dying within hours of onset from blockage of blood flow to the lungs. The diagnosis of PE involves evaluating risk factors, performing physical exams, blood tests like D-dimer, and imaging tests like CT pulmonary angiography or ventilation-perfusion scans. Effective treatment requires identifying patients at high risk of complications or death.
This document provides information on imaging of aortic dissection, including:
1. CT is the most sensitive imaging method for detecting aortic dissection, showing features like an intimal flap separating the true and false lumens.
2. Risk factors include hypertension, male sex, advanced age, and connective tissue disorders. Acute aortic dissections are classified as Stanford type A or B.
3. Management decisions are based on details of the dissection like entry/exit points and branch vessel involvement that affect outcomes.
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
Trans-esophageal echocardiography (TEE) uses ultrasound to obtain high-quality images of the heart and surrounding structures. It involves inserting a probe with an ultrasound transducer at the tip through the mouth and esophagus. TEE provides clearer images than transthoracic echocardiography as the esophagus is directly behind the heart. A TEE exam involves systematically imaging the heart in various planes as the transducer is advanced and manipulated. Standard views include the mid-esophageal four-chamber, two-chamber, aortic, and RV inflow-outflow views. Real-time 3D TEE can provide en face views of structures.
The document discusses aortic regurgitation, including its anatomy, etiology, pathophysiology, epidemiology, clinical manifestations, diagnosis, and management. Key points include:
- Aortic regurgitation occurs when the aortic valve fails to close properly, allowing blood to flow back into the left ventricle during diastole.
- Causes include conditions like infective endocarditis, bicuspid aortic valve, hypertension, and Marfan syndrome.
- In acute severe cases, a rapid increase in left ventricular preload can cause pulmonary edema and cardiogenic shock. Chronic cases involve left ventricular dilation and hypertrophy to compensate for the increased preload over time.
- Physical exam may
The document discusses constrictive pericarditis, providing details on:
1) The pathology of constrictive pericarditis which involves thickening and scarring of the pericardium leading to loss of elasticity.
2) The pathophysiology of constrictive pericarditis where the inelastic pericardium constrains cardiac filling and prevents adaptation to volume changes.
3) Key diagnostic features of constrictive pericarditis seen on echocardiogram include septal bounce, rapid early diastolic mitral inflow, and increased mitral annular velocities that rise with inspiration.
Pulmonary Embolism- Diagnosis by Dr.Tinku JosephDr.Tinku Joseph
This document discusses diagnostic tests for pulmonary embolism (PE). It describes various imaging studies including chest x-rays, V/Q scans, CT scans, pulmonary angiograms, and echocardiograms. It also discusses laboratory tests like D-dimer, troponin, and BNP levels. CT pulmonary angiography is becoming the initial test of choice due to its speed and ability to directly visualize PEs. V/Q scans remain useful in pregnant patients due to their lower radiation exposure compared to CT scans. No single test is perfect, so a combination of clinical assessment, imaging, and lab tests is usually needed to diagnose PE.
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
This document provides an overview of pulmonary embolism (PE), including its definition, risk factors, types, natural history, symptoms, signs, investigations, diagnosis, and management. PE is defined as obstruction of the pulmonary artery or its branches by material such as thrombus. It discusses diagnostic tests like CT, VQ scan, echocardiogram and their role in determining pretest probability. Management involves anticoagulation with drugs like heparin, warfarin, rivaroxaban. Thrombolysis may be used for massive PE while inferior vena cava filters can be placed in patients who cannot receive anticoagulation.
The document discusses pulmonary embolism, which is the blockage of pulmonary arteries by blood clots or other materials. It defines pulmonary embolism and discusses its incidence, risk factors including deep vein thrombosis, clinical features such as chest pain and dyspnea, pathophysiology involving right heart strain, diagnostic studies, and treatment including anticoagulation with heparin and warfarin as well as surgical interventions in severe cases.
This document discusses pulmonary embolism (PE), which refers to obstruction of the pulmonary artery or its branches by a thrombus (blood clot). PE can be caused by factors that increase clotting like surgery, trauma, or heart failure. When a thrombus blocks a pulmonary vessel, it impairs gas exchange and increases pulmonary vascular resistance, raising pressure in the pulmonary artery and overworking the right ventricle. Diagnosis involves tests like ventilation-perfusion scans and treatment focuses on anticoagulation, thrombolytic drugs, or occasionally surgery to remove clots. Nursing care aims to prevent clots, monitor for complications, manage pain and oxygen therapy.
Pulmonary embolism is a blockage in the pulmonary artery or its branches, usually caused by blood clots from deep vein thrombosis. It occurs in over 600,000 patients annually in the US and contributes to 50,000-200,000 deaths per year. Common signs and symptoms include dyspnea, chest pain, tachycardia, and hypoxia. Diagnostic tests include chest x-rays, CT scans, D-dimer tests, V/Q scans, and blood gas analysis. Treatment involves anticoagulant therapy, thrombolytic therapy, bed rest, and in severe cases, surgical embolectomy.
GEMC: Acute Pulmonary Emergencies: Pulmonary Embolism, Pulmonary Edema and Pa...Open.Michigan
This is a lecture by Dr. Michele M. Nypaver from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: The Emergency Department Management of Pulmonary EmbolismOpen.Michigan
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc.
The document discusses pulmonary embolism (PE), which is a blockage in the pulmonary artery caused by blood clots that travel from deep veins. It covers the definition, sources, risk factors including Virchow's triad, pathogenesis, clinical presentation, differential diagnosis, investigations such as D-dimer and imaging tests, and management including anticoagulation, thrombolytic therapy, and prevention through prophylaxis. The management section also describes emergency resuscitation, thrombolysis to relieve obstruction, heparin therapy, warfarin therapy over 3-6 months, vena cava filters for recurrent cases, and embolectomy for massive PE.
This document discusses pulmonary embolism (PE). PE occurs in about 10% of maternal mortality cases and has an incidence of 1 in 7,000 pregnancies. 70% of women who develop PE have a pre-existing deep vein thrombosis (DVT). Massive PE leads to right heart failure and hemodynamic instability when over 50% of the pulmonary arteries are blocked. Investigations to diagnose PE include lung scans, MRI, pulmonary angiography and echocardiography. D-dimer and coagulation tests can also help in diagnosis, while chest X-rays and ECG may show signs of PE. PE treatment focuses on anticoagulation to prevent further clots.
This document discusses imaging in pulmonary embolism. It begins with background information on pulmonary embolism, noting that it is a life-threatening condition caused by blood clots blocking arteries in the lungs. It then reviews facts about the prevalence and mortality of pulmonary embolism. The document then discusses various imaging modalities for pulmonary embolism including chest x-rays, ultrasound, V/Q scans, CT pulmonary angiography, and echocardiography. It provides details on the techniques and findings of these different tests.
1) Pulmonary embolism is the third most common cause of death and second most common cause of unexpected death, with an incidence of 355,000 cases per year and 240,000 deaths per year in the US.
2) Clinical presentation can include chest pain, dyspnea, tachycardia, syncope, and hemoptysis. Diagnosis is often missed due to non-specific symptoms.
3) Diagnostic tests include D-dimer, V/Q scan, CT pulmonary angiogram, pulmonary angiogram, and echocardiogram. Treatment depends on severity and includes anticoagulation, thrombolysis, catheter-directed thrombolysis, surgical embolect
This document summarizes contemporary management of pulmonary embolism (PE). It discusses that PE is a common cause of death in the US, killing 50,000-200,000 people annually. Massive PE has a much higher mortality than non-massive PE. The document reviews risk factors, diagnostic testing including D-dimer, V/Q scan, CT, and echocardiography. Treatment options discussed include anticoagulation with heparin, thrombolysis for unstable patients or those with RV dysfunction, and percutaneous interventions.
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 summarizes the diagnostic criteria and causes of misdiagnosis for computed tomography angiography (CTA) of pulmonary embolism (PE). It outlines the diagnostic criteria for acute and chronic PE seen on CTA images, including signs such as intraluminal filling defects and vessel occlusion. It then discusses numerous technical, anatomic and pathological factors that can cause misdiagnosis of PE on CTA images, such as respiratory motion artifact, image noise, vascular bifurcations and lymph node enlargement. Patient-related, equipment and interpretation factors are all reviewed in detail to help reduce incorrect diagnosis.
The document summarizes the major blood vessels and components of blood. It describes the aorta as the largest artery originating from the left ventricle of the heart and distributing oxygenated blood throughout the body. It notes the vena cavae return deoxygenated blood from the body to the right atrium. It also explains pulmonary veins carry oxygenated blood from the lungs to the left atrium, unlike other veins which carry deoxygenated blood. Finally, it outlines arteries carry blood away from the heart to deliver oxygen, nutrients, and remove wastes from cells in various organs like the lungs, tissues, kidneys and intestines.
These are the slides from a presentation I recently gave at work. It demonstrates two fascinating cases [one massive & one submassive PE] & lends itself to a review of the literature assessing the roles and evidence behind thrombolysis for pulmonary embolism.
Covered includes the MAPPET-3, MOPPET & PEITHO trials.
Thrombotic and nonthrombotic pulmonary embolismGamal Agmy
This document discusses various types of pulmonary embolism including thrombotic, nonthrombotic, septic, fat, amniotic fluid, tumor, air, talc, cement, iodinated oil, and foreign body embolism. It provides details on multidetector CT findings of acute pulmonary embolism including the tram-track sign and rim sign seen on contrast-enhanced images. Imaging findings of chronic thromboembolic pulmonary hypertension include vascular abnormalities such as webs/bands and parenchymal abnormalities like bronchial artery dilatation and mosaic perfusion patterns.
The document discusses pulmonary embolism (PE), which is a blockage of an artery in the lungs by a substance that has traveled from elsewhere in the body, such as a blood clot. Deep vein thrombosis (DVT) in the legs is the most common source of PE. Key signs and symptoms of PE include shortness of breath, chest pain, and tachycardia. Diagnostic tests include chest x-rays, CT scans, ventilation-perfusion scans, echocardiograms, and D-dimer tests. Treatment focuses on anticoagulation medications to prevent further clotting.
Hemodynamic monitoring measures factors that influence blood flow and pressure. It aids in diagnosing, monitoring, and managing critically ill patients by measuring things like cardiac output, fluid status, and the body's response to therapies. The document discusses the components, placement, and use of pulmonary artery catheters to obtain important hemodynamic measurements, as well as how to interpret the results and optimize cardiac output in critical care patients. Potential complications of PA catheters are also reviewed.
Hemodynamic monitoring measures factors that influence the force and flow of blood in order to aid in diagnosing, monitoring, and managing critically ill patients. It involves using pulmonary artery catheters and transducers to obtain pressures and other cardiovascular measurements that provide information on conditions like shock states and help guide treatment decisions. Potential risks and complications require careful use of these monitoring techniques in appropriate clinical situations.
This document discusses extrapleural pneumonectomy, a surgical procedure to remove an affected lung along with parts of the diaphragm, pleura, and pericardium for treatment of malignant mesothelioma. It notes that chest wall resection is a safe and effective option for localized chest wall recurrence of malignant pleural mesothelioma according to a journal article.
This document provides an introduction to hemodynamic monitoring, which involves measuring factors that influence blood flow and pressure. It defines hemodynamic monitoring and outlines its purposes, which include diagnosing and managing shock states, determining fluid status, and measuring cardiac output. The document discusses indications for hemodynamic monitoring as well as contraindications for invasive pulmonary artery catheters. It also reviews important hemodynamic values and concepts, pulmonary artery catheter insertion and positioning, waveform analysis, and removal of pulmonary artery catheters.
This document discusses pulmonary stenosis (PS), a congenital heart defect where the pulmonary valve is narrowed. It accounts for 20-30% of congenital heart disease. PS can be valvular, subvalvular, or supravalvular. Symptoms range from none to right heart failure. Diagnosis involves listening for a systolic murmur and click, and imaging like echocardiogram and catheterization to measure pressures and gradients. Treatment is usually balloon valvuloplasty or surgery if severe.
Clinical features & Diagnosis of Pulmonary Vascular DiseasesBala Murugan
The document discusses pulmonary embolism (PE), providing details on:
- Common clinical features of PE include chest pain, shortness of breath, elevated heart rate, and potentially shock.
- Initial investigations include D-dimer, chest X-ray, EKG, and CT pulmonary angiogram to confirm the diagnosis.
- Severe PE can be life threatening by blocking blood flow from the heart to the lungs.
Abnormal drainage of the pulmonary veins jf.pptxJackfrimpong
Total anomalous pulmonary venous return (TAPVR) is a rare congenital heart defect where the pulmonary veins do not connect normally to the left atrium, and instead connect abnormally to the right side of the heart or other veins. There are several types of TAPVR based on where the pulmonary veins connect. Symptoms in newborns include cyanosis and breathing difficulties. The causes are generally unknown but may involve genetic factors. The goal of surgery is to reconnect the pulmonary veins to the left atrium and close any abnormal connections, in order to restore normal blood flow through the heart. Complications can include enlarged heart and lungs, arrhythmias, and even death in severe cases.
Diagnosis & Classification of Pulmonary Hypertensionmediwaves
Pulmonary hypertension is classified into 5 categories based on the underlying pathophysiology: (1) pulmonary arterial hypertension, (2) pulmonary hypertension due to left heart disease, (3) pulmonary hypertension due to lung diseases/hypoxemia, (4) chronic thromboembolic pulmonary hypertension, and (5) miscellaneous. Echocardiography, chest imaging, pulmonary function tests, and right heart catheterization are used in evaluating and diagnosing pulmonary hypertension.
Pulmonary embolism (PE) can be detected and investigated through several tests:
Pulse oximetry monitors for hypoxemia and oxygen supplementation is initiated, while further tests are done. Electrocardiograms can show changes indicating conditions like pulmonary embolism or right heart strain. Arterial blood gases may demonstrate hypoxemia, hypocapnia, or acidosis in PE. Chest x-rays can reveal signs of PE like enlarged heart size or perfusion deficits on lung scans. D-dimer tests if elevated suggest a thrombus, while normal levels rule out recent clots. CT pulmonary angiograms are best to diagnose or rule out PE due to speed, availability and ability to detect other lung abnormalities
Brief Presentation on clinical examination of Cardio Vascular System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
CYANOTIC CONGENITAL HEART DISEASES WITH DECREASED BLOOD FLOWbadrik19
This document discusses cyanosis and its causes in neonates. It begins by defining cyanosis as a bluish tinge of the skin and mucous membranes, detectable when hemoglobin is reduced by more than 5g% or oxygen saturation is below 85%. It then lists various pulmonary, cardiac, central nervous system, metabolic, hematologic, and infectious conditions that can cause cyanosis in newborns. The majority of the document focuses on describing tetralogy of Fallot, including its characteristic features, pathophysiology, clinical presentation, diagnosis, and management. It provides details on the anatomy, causes, hypoxic spells, and treatment approaches for tetralogy of Fallot.
This document provides details on cardiovascular examination including cardinal symptoms, chest pain characteristics, breathlessness causes, palpitations description, syncope causes, and edema types. It also describes techniques for cardiovascular auscultation including listening locations, sounds, murmur characteristics like timing, intensity location, loudness, quality, pitch, radiation, and changes with maneuvers.
The document summarizes various congenital heart defects that can cause cyanosis in infants, including tetralogy of Fallot, transposition of the great arteries, truncus arteriosus, total anomalous pulmonary venous return, tricuspid atresia, pulmonary atresia, and Ebstein's anomaly. It describes the characteristic features, causes, evaluations, and treatments for each condition. For the scenario presented, the assistant would start prostaglandin E1 treatment and call cardiology to perform an echocardiogram to determine the specific heart defect.
Cyanotic congenital heart disease is characterized by a right-to-left shunt and decreased pulmonary blood flow, causing hypoxemia and cyanosis. Tetralogy of Fallot is a common cyanotic heart defect where there is a ventricular septal defect, right ventricular outflow tract obstruction, overriding aorta, and right ventricular hypertrophy. Without surgical intervention, most patients would not survive beyond childhood. Complete repair aims to relieve obstruction and close defects, but may require multiple staged procedures. Preoperative evaluation focuses on assessing cyanosis, growth, polycythemia, and identifying other anomalies to optimize timing of repair.
A 30-minute talk, presented as part of the weekly teaching activities in Alder Hey Children's Hospital (Liverpool, UK). It addresses PDA evaluation in children - starting with embryology & anatomy with the basis behind physiological closure versus patency after birth. What is the role of echo study in diagnosing/evaluating PDA? Modes used with some clear movies? Its limitations?
This document discusses functional echocardiography for assessing cardiovascular function in neonates. Targeted neonatal echocardiography can be used to evaluate conditions like patent ductus arteriosus, cyanosis, and shock. Functional echocardiography longitudinally assesses cardiac function, blood flows, and shunts. It provides objective evaluation of cardiac output and tissue perfusion that indirect measures cannot. Views used in echocardiography include four-chamber, ductal, and superior vena cava flow views. Superior vena cava flow can estimate systemic blood flow and cerebral blood flow. Functional echocardiography is useful for hypotensive neonates to differentiate causes and guide management.
This document discusses a case of Ebstein's anomaly in a 57-year-old male presenting with shortness of breath and leg swelling. Echocardiography and ECG findings were consistent with Ebstein's anomaly. Key features of Ebstein's anomaly include apical displacement of the tricuspid valve leading to atrialization of the right ventricle. Clinical manifestations depend on severity and include heart failure in neonates or arrhythmias and emboli in milder cases. Management involves surgery for symptomatic patients and monitoring for complications in asymptomatic cases.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
3. Blood flow to the lungsBlood flow to the lungs
Venous system fromVenous system from
upper and lower partsupper and lower parts
of the body drains intoof the body drains into
the right atrium andthe right atrium and
then pumped into thethen pumped into the
right ventricleright ventricle
The right ventricleThe right ventricle
pumps blood to thepumps blood to the
lungslungs
4. The Clot TravelsThe Clot Travels
So if a clot occurs in anySo if a clot occurs in any
vein it will eventually (if itvein it will eventually (if it
breaks free) end up in thebreaks free) end up in the
right side of the heartright side of the heart
The heart then pumps itThe heart then pumps it
into the pulmonaryinto the pulmonary
arteriesarteries
As the pulmonary arteryAs the pulmonary artery
becomes smaller, thebecomes smaller, the
blood clot will becomeblood clot will become
caught in the lungs. Thiscaught in the lungs. This
is a Pulmonary Embolismis a Pulmonary Embolism
5. Lung Blood FlowLung Blood Flow
Typically there isTypically there is
more flow to the lowermore flow to the lower
area of the lungs, duearea of the lungs, due
to gravityto gravity
PEs can occurPEs can occur
anywhere in the lung,anywhere in the lung,
but more are seen inbut more are seen in
the lower portion thanthe lower portion than
upper portionupper portion
No preference toNo preference to
which side it occurswhich side it occurs
6. Saddle EmbolusSaddle Embolus
This is where a clotThis is where a clot
occurs at the point ofoccurs at the point of
the pulmonary arterythe pulmonary artery
branchingbranching
This can be fatal, dueThis can be fatal, due
to the large amount ofto the large amount of
blood flow that isblood flow that is
inhibitedinhibited
7. Incidence of PEIncidence of PE
In the UK, PE occurs in 3-4 per 10 000In the UK, PE occurs in 3-4 per 10 000
peoplepeople
This could be possibly higher as this isThis could be possibly higher as this is
only based on clinical dataonly based on clinical data
Between 2005-2008 it was mentioned onBetween 2005-2008 it was mentioned on
the death certificates of 12 - 13 000the death certificates of 12 - 13 000
peoplepeople
It is thought that this figure could be asIt is thought that this figure could be as
high as 60 000 per year in the UKhigh as 60 000 per year in the UK
(NICE 2013)(NICE 2013)
8. DiagnosingDiagnosing
A large number ofA large number of
patients arepatients are
misdiagnosed andmisdiagnosed and
only found to have aonly found to have a
PE on autopsyPE on autopsy
We can test for themWe can test for them
but results can comebut results can come
back as negative (orback as negative (or
inconclusive)inconclusive)
9. DiagnosingDiagnosing
Most PEs come fromMost PEs come from
Deep VenousDeep Venous
Thrombosis (DVT)Thrombosis (DVT)
Most DVTs (75%) comeMost DVTs (75%) come
from the legs,from the legs,
20% of clots embolise20% of clots embolise
with higher incidencewith higher incidence
above the knee ratherabove the knee rather
than belowthan below
The emboli travel via theThe emboli travel via the
Inferior Vena Cava (IVC),Inferior Vena Cava (IVC),
to the heart, to the lungsto the heart, to the lungs
PEPE
10. In the lungs the blood clotIn the lungs the blood clot
gets lodged in thegets lodged in the
pulmonary artery, sopulmonary artery, so
there is no morethere is no more
perfusion to that area ofperfusion to that area of
lung, thus ventilationlung, thus ventilation
occurs without perfusionoccurs without perfusion
forming a dead spaceforming a dead space
The blood that shouldThe blood that should
have gone to that area ishave gone to that area is
then diverted to otherthen diverted to other
areas of the lung, thisareas of the lung, this
causes a V/Q Mismatchcauses a V/Q Mismatch
11. Lung InfarctLung Infarct
There is also an increaseThere is also an increase
in resistance to bloodin resistance to blood
flow, this can cause aflow, this can cause a
cardiac arrestcardiac arrest
The lungs may infarct, butThe lungs may infarct, but
this is difficult due to thethis is difficult due to the
dual blood supply, fromdual blood supply, from
both the pulmonary arteryboth the pulmonary artery
and also from the aorta,and also from the aorta,
as it sends branches toas it sends branches to
the lungthe lung
12. Risk FactorsRisk Factors
Orthopaedic Procedure – THR, TKR, #sOrthopaedic Procedure – THR, TKR, #s
Lack of mobilisationLack of mobilisation
No thrombo-prophylaxis – TEDS, Flowtrons,No thrombo-prophylaxis – TEDS, Flowtrons,
Dalteparin , WarfarinDalteparin , Warfarin
Abdo / Pelvic surgery - especially for CaAbdo / Pelvic surgery - especially for Ca
ObesityObesity
Women >30yrs on oral contraceptive who smokeWomen >30yrs on oral contraceptive who smoke
Hyper-coaguable state – Protein C & S deficiencies,Hyper-coaguable state – Protein C & S deficiencies,
Factor V LeidenFactor V Leiden
PregnancyPregnancy
13. SymptomsSymptoms
May be normalMay be normal
TachycardiaTachycardia
AFAF
Reduced chest movementReduced chest movement
(due to pain)(due to pain)
TachypnoeaTachypnoea
Pleural rubPleural rub
Haemoptysis (especially inHaemoptysis (especially in
lung infarction)lung infarction)
Low grade feverLow grade fever
Signs of DVTSigns of DVT
PP22 Sound,Sound,
Right Heart failure-Right Heart failure- CO,CO,
JVP,JVP, BP and PerfusionBP and Perfusion
PressurePressure
14. DiagnosisDiagnosis
ABG –ABG – pH /pH / pCOpCO22// pOpO22 (or lower normal range)(or lower normal range)
Respiratory AlkalosisRespiratory Alkalosis
pOpO22 due to V/Q Mismatchdue to V/Q Mismatch
pCOpCO22 due to tachypnoea (trying to make room for Odue to tachypnoea (trying to make room for O2)2)
Alveolar-arterial oxygen (A-a) gradientAlveolar-arterial oxygen (A-a) gradient
PPAAOO22 - P- PaaOO22
Alone they are not diagnostic of pulmonary embolismAlone they are not diagnostic of pulmonary embolism
(PE), but they may be useful in excluding the diagnosis(PE), but they may be useful in excluding the diagnosis
of PE if their values fall within the normal rangeof PE if their values fall within the normal range
15. Alveolar-arterial oxygen (A-a)Alveolar-arterial oxygen (A-a)
gradientgradient
PPAAOO22 - P- PaaOO22 should equal (Age (years) / 4) + 4should equal (Age (years) / 4) + 4
PPAAOO22 = [(F= [(FiiOO22) x (760 – 47)] – (P) x (760 – 47)] – (PaaCOCO22 / 0.8)/ 0.8)
Barometric Pressure = 760mmHgBarometric Pressure = 760mmHg
Water Vapour Pressure = 47mmHgWater Vapour Pressure = 47mmHg
Respiratory Coefficient = 0.8Respiratory Coefficient = 0.8
UseUsePPaaOO22 andandPPaaCOCO22 in mmHg not KPain mmHg not KPa
Eg 40 Yr old,Eg 40 Yr old,
FFiiOO22 0.60.6
PPaaCOCO22 32.5 mmHg32.5 mmHg (4.27KPa)(4.27KPa)
PPaaOO22 65 mmHg (8.55KPa)65 mmHg (8.55KPa)
PPAAOO22 =(0.6 x 713) – 40.6 = 387.2=(0.6 x 713) – 40.6 = 387.2
PPAAOO22 - P- PaaOO22 = 387.2 – 65 = 322.2= 387.2 – 65 = 322.2
(40/4) = 10 (+4) = 14(40/4) = 10 (+4) = 14
Therefore 322.2 > 14Therefore 322.2 > 14
So if the A-a gradient > 14 it may be indicative of a PESo if the A-a gradient > 14 it may be indicative of a PE
16. Chest X-rayChest X-ray
Chest X ray – most common finding with aChest X ray – most common finding with a
PE is a normal x-rayPE is a normal x-ray
But they are useful as X-rays help to ruleBut they are useful as X-rays help to rule
out pneumonia and pneumothorax asout pneumonia and pneumothorax as
causes of dyspnoea etccauses of dyspnoea etc
Possible signs indicating a PE are asPossible signs indicating a PE are as
followsfollows
17. Hamptons HumpHamptons Hump
Not always seenNot always seen
Wedged shapedWedged shaped
pleural based lesionpleural based lesion
PE in one areaPE in one area
(Bottom arrow) and(Bottom arrow) and
everywhere else iseverywhere else is
infarctinfarct
Causes pleurisy,Causes pleurisy,
irritationirritation
18. Westermark SignWestermark Sign
On this X-ray PE is inOn this X-ray PE is in
Left lungLeft lung
Increase in blood flowIncrease in blood flow
to right side.to right side.
Minimal blood flowMinimal blood flow
seen to Left lungseen to Left lung
So the side that looksSo the side that looks
clearer is the sideclearer is the side
with reduced bloodwith reduced blood
flow, therefore the clotflow, therefore the clot
19. ECGECG
SSIIQQIIIIIITTIIIIII
Can be seen in anyCan be seen in any
cor-pulmonalecor-pulmonale
syndrome wheresyndrome where
pulmonary arterypulmonary artery
systolic pressure issystolic pressure is
elevatedelevated
Eg Normal PQRSTEg Normal PQRST
20. ECGECG
LeadLead II
Exaggerated S waveExaggerated S wave
LeadLead IIIIII
Exaggerated Q waveExaggerated Q wave
T Wave inversionT Wave inversion
Not specific to PE, butNot specific to PE, but
gets you to possibly thinkgets you to possibly think
of the diagnosisof the diagnosis
21. ECG – Precordial LeadsECG – Precordial Leads
Peaked T wavesPeaked T waves
V1-V4V1-V4
Makes you think about :-Makes you think about :-
Right Heart Strain,Right Heart Strain,
PE, Cor-pulmonalePE, Cor-pulmonale
Tachycardia nearlyTachycardia nearly
always seen in PE butalways seen in PE but
also most other problemsalso most other problems
so non-specificso non-specific
22. D-dimerD-dimer
By-product of fibrinBy-product of fibrin
degradationdegradation
As clot degraded byAs clot degraded by
enzymes, Fibrinenzymes, Fibrin
Degradation ProductsDegradation Products
(FDP) are released, one(FDP) are released, one
of these is the D-dimerof these is the D-dimer
Little clots in body releaseLittle clots in body release
D-dimers, therefore if testD-dimers, therefore if test
+ve - do not know if it is+ve - do not know if it is
from a PE,from a PE,
But test is so sensitiveBut test is so sensitive
that if no D-dimer ( –ve)that if no D-dimer ( –ve)
you can rule out PEyou can rule out PE
23. UltrasoundUltrasound
Non-invasiveNon-invasive
Looks at lower limbsLooks at lower limbs
Doppler USS looks atDoppler USS looks at
vein for flow andvein for flow and
compressibilty to seecompressibilty to see
if clot presentif clot present
24. USS ResultsUSS Results
If +ve for DVT and patient hasIf +ve for DVT and patient has
respiratory distress symptomsrespiratory distress symptoms
you can rule in a PE, since theyou can rule in a PE, since the
DVTs can embolise easily andDVTs can embolise easily and
enter the lungs causingenter the lungs causing
respiratory problemsrespiratory problems
If -ve for DVT, unsure whetherIf -ve for DVT, unsure whether
there is a PE or not, as a clotthere is a PE or not, as a clot
from other part of body mayfrom other part of body may
have embolised the lung, or ahave embolised the lung, or a
whole DVT may have travelledwhole DVT may have travelled
to the lungto the lung
So a –ve result does not give aSo a –ve result does not give a
thorough answer, whilst a +vethorough answer, whilst a +ve
result may rule it inresult may rule it in
25. ECHOECHO
Sometimes beneficialSometimes beneficial
The right ventricleThe right ventricle
pumps blood to lungspumps blood to lungs
If clot is present theIf clot is present the
pressure at site of clotpressure at site of clot
increases and soincreases and so
does the pressure indoes the pressure in
the right ventriclethe right ventricle
26. ECHOECHO
The severity of this PulmonaryThe severity of this Pulmonary
Artery Pressure (PAP) and theArtery Pressure (PAP) and the
severity of the clot, is found byseverity of the clot, is found by
looking at the tricuspid valvelooking at the tricuspid valve
and noting how much regurgeand noting how much regurge
occurs (Tricuspid jet)occurs (Tricuspid jet)
If tricuspid jet is high then PAPIf tricuspid jet is high then PAP
differential between RA anddifferential between RA and
RV is great and the clot burdenRV is great and the clot burden
is largeis large
All these tests may help in theAll these tests may help in the
possible diagnosis of a PE, butpossible diagnosis of a PE, but
are not definitive testsare not definitive tests
27. VQ ScanVQ Scan
Nuclear medicine scanNuclear medicine scan
Looks at perfusion and ventilationLooks at perfusion and ventilation
In pneumonia for example, you would getIn pneumonia for example, you would get
decreased perfusion and decreased ventilationdecreased perfusion and decreased ventilation
due to the purulent material present this is adue to the purulent material present this is a
“Matched Deficit”“Matched Deficit”
In a PE there is decreased perfusion of the lungIn a PE there is decreased perfusion of the lung
in the area but ventilation remains the same thisin the area but ventilation remains the same this
is an “Unmatched Deficit”is an “Unmatched Deficit”
Does Not affect patient in renal failureDoes Not affect patient in renal failure
Impaired view if patient has pneumonia etcImpaired view if patient has pneumonia etc
28. VQ ScanVQ Scan
The patients ventilation isThe patients ventilation is
assessed by themassessed by them
breathing in Xenonbreathing in Xenon
For perfusion the patientFor perfusion the patient
is injected with Technigasis injected with Technigas
(T(Tcc99mMAA)99mMAA)
Use Gamma Camera (aUse Gamma Camera (a
glorified Geiger counter)glorified Geiger counter)
to measure the nuclearto measure the nuclear
materialmaterial
29. Probability of PEProbability of PE
Normal - Full ventilationNormal - Full ventilation
and perfusion seenand perfusion seen
Low Pobability for PE –Low Pobability for PE –
(<20%)(<20%)
Intermediate probabilityIntermediate probability
for PE-for PE- V andV and P inP in
same areasame area
(Matched deficit) (20-(Matched deficit) (20-
80%)80%)
High Probability for PE –High Probability for PE –
Normal V andNormal V and P (Un-P (Un-
Matched deficit) (>80%)Matched deficit) (>80%)
30. CTPACTPA
Contrast injected into body,Contrast injected into body,
CT Scan obtained as this isCT Scan obtained as this is
occurringoccurring
Vessels viewed on end andVessels viewed on end and
seen if they light up withseen if they light up with
contrast.contrast.
If only partially light up withIf only partially light up with
contrast there may be a bloodcontrast there may be a blood
clot present stopping flowclot present stopping flow
Do not use if in renal failureDo not use if in renal failure
((Creatanine) (could useCreatanine) (could use
HCOHCO33 cover to stopcover to stop
nephrotoxic effect of contrast)nephrotoxic effect of contrast)
Unlike VQ Scan if patient hasUnlike VQ Scan if patient has
a pneumonia it will not affecta pneumonia it will not affect
resultsresults
31. CTPACTPA
In 2006 ‘The Christopher Study’ showed that ifIn 2006 ‘The Christopher Study’ showed that if
you perform a CTPA that was negative for ayou perform a CTPA that was negative for a
blood clot with a –ve D-dimer result, it wasblood clot with a –ve D-dimer result, it was
shown to be safe to withhold anticoagulation,shown to be safe to withhold anticoagulation,
this supports the reasoning that you should notthis supports the reasoning that you should not
do a repeat CT scan if first found to be –ve for ado a repeat CT scan if first found to be –ve for a
clotclot
The CTPA is the test of choice for diagnosis ofThe CTPA is the test of choice for diagnosis of
PE, if unable to perform this due toPE, if unable to perform this due to
Creatanine, the next choice would be a VQCreatanine, the next choice would be a VQ
Scan.Scan.
BUT, these are not the ‘Gold Standard’BUT, these are not the ‘Gold Standard’
32. Gold StandardGold Standard
Pulmonary Angiogram –Pulmonary Angiogram –
Most accurate test, butMost accurate test, but
not always best fornot always best for
patient (most invasive)patient (most invasive)
Catheter inserted intoCatheter inserted into
right side of the heart,right side of the heart,
dye is injected directlydye is injected directly
into pulmonary artery,into pulmonary artery,
observed underobserved under
fluoroscopyfluoroscopy
Dangerous,Dangerous,
mortality rate,mortality rate,
especially in patients withespecially in patients with
PEPE
33. TreatmentTreatment
AnticoagulationAnticoagulation
Eg Warfarin / HeparinEg Warfarin / Heparin
-Blood thinning-Blood thinning
-Prevent new clots-Prevent new clots
Non-thrombolyticNon-thrombolytic
treatmenttreatment
ThrombolyticsThrombolytics
-Dissolve Clot,-Dissolve Clot,
-not solely used for-not solely used for
PE treatmentPE treatment
DVT Treatment 3-6 monthsDVT Treatment 3-6 months
PE Treatment 6-9 monthsPE Treatment 6-9 months
34. IVC FilterIVC Filter
If anticoagulationIf anticoagulation
treatmenttreatment
contraindicatedcontraindicated IVCIVC
FilterFilter
If clot travels it getsIf clot travels it gets
caught in IVC Filtercaught in IVC Filter
35. IVC FilterIVC Filter
It is possible for blood clot to be caught andIt is possible for blood clot to be caught and
develop in IVC filterdevelop in IVC filter
Cochrane Collaboration recommends IVC forCochrane Collaboration recommends IVC for
1.1. Recurrent PE despite use of anticoagulation,Recurrent PE despite use of anticoagulation,
or in absolute contra-indication toor in absolute contra-indication to
anticoagulationanticoagulation
2.2. Proximal DVT with massive pulmonaryProximal DVT with massive pulmonary
thrombosis – next one could kill patientthrombosis – next one could kill patient
3.3. Trauma Patient – needing operationTrauma Patient – needing operation
36. AnticoagulationAnticoagulation
Ideally start Fast acting and slow acting anticoagulants,Ideally start Fast acting and slow acting anticoagulants,
when slow acting anticoagulants at desired level, stopwhen slow acting anticoagulants at desired level, stop
fast actingfast acting
Fast acting -Heparin productsFast acting -Heparin products
Heparin (IV) orHeparin (IV) or
Low Molecular Weight Heparin (S/C)Low Molecular Weight Heparin (S/C)
Slow acting – Vitamin K AntagonistsSlow acting – Vitamin K Antagonists
WarfarinWarfarin
37. Fast ActingFast Acting
Heparin productsHeparin products
IV HeparinIV Heparin
Aim for therapeutic APTTAim for therapeutic APTT
Can be startedCan be started
immediatelyimmediately
Quick AnticoagulationQuick Anticoagulation
actionaction
If bleeding occurs canIf bleeding occurs can
stop it and reducedstop it and reduced
effects occur within feweffects occur within few
hours as it has a shorthours as it has a short
half life (45-60min)half life (45-60min)
38. Heparin InducedHeparin Induced
ThrombocytopaeniaThrombocytopaenia
Can cause highest incidence of HITCan cause highest incidence of HIT
-Usually occurs 5-14 days after starting-Usually occurs 5-14 days after starting HeparinHeparin
(even if discontinued) or sooner if previously had(even if discontinued) or sooner if previously had
heparinheparin
-Immune response to heparin-Immune response to heparin
-Antibodies combine with heparin and platelets-Antibodies combine with heparin and platelets
causing platelet activation of microparticles whichcausing platelet activation of microparticles which
initiate the formation of blood clots; the plateletinitiate the formation of blood clots; the platelet
count falls as a result, So,count falls as a result, So,
-Platelet count drops by >50%-Platelet count drops by >50%
-Get hyper-coaguable state, get more clotting-Get hyper-coaguable state, get more clotting
even though platelet count loweven though platelet count low
-If this occurs change from heparin products-If this occurs change from heparin products
39. Fast ActingFast Acting
Low Molecular Weight Heparin (SC)Low Molecular Weight Heparin (SC)
Eg clexane, dalteparin, fondaparinuxEg clexane, dalteparin, fondaparinux
Give twice per day dependent on Creatanine Clearance (CrCl)Give twice per day dependent on Creatanine Clearance (CrCl)
(20-29ml/min)(20-29ml/min)
Or if CrCl ≥30ml/min give once a dayOr if CrCl ≥30ml/min give once a day
Problem is if given, anticoagulation is present for next 12 orProblem is if given, anticoagulation is present for next 12 or
24hrs (as half life is four times as long as heparin, about 4 hrs)24hrs (as half life is four times as long as heparin, about 4 hrs)
Incidence of HIT is lower than IV HeparinIncidence of HIT is lower than IV Heparin
Easy and quick to administerEasy and quick to administer
Also available is rivaroxaban, a fast acting oral medication, TheAlso available is rivaroxaban, a fast acting oral medication, The
effects lasts 8 to 12 hours, but factor Xa activity does not return toeffects lasts 8 to 12 hours, but factor Xa activity does not return to
normal within 24 hours so once-daily dosing is possible.normal within 24 hours so once-daily dosing is possible.
40. To work out CrClTo work out CrCl
Takes into accountTakes into account
Patients Age, Gender,Patients Age, Gender,
Ideal Weight (Kg) SerumIdeal Weight (Kg) Serum
Creatanine (μmol/L) fromCreatanine (μmol/L) from
last 24hrslast 24hrs
Use the equationUse the equation
((140-Age) x (ideal weight) /((140-Age) x (ideal weight) /
Cr) x1.23(male) = CrClCr) x1.23(male) = CrCl
((140-Age) x (ideal weight) /((140-Age) x (ideal weight) /
Cr) x1.04(female) = CrClCr) x1.04(female) = CrCl
Use STH treatment ofUse STH treatment of
Thromboembolic DiseaseThromboembolic Disease
Dalteparin PrescriptionDalteparin Prescription
ChartChart
41. ExamplesExamples
Eg Age 67 yrsEg Age 67 yrs
Gender - MaleGender - Male
Ideal Weight 85KgIdeal Weight 85Kg
Cr 73 μmol/LCr 73 μmol/L
Eg (140-67 = 73)Eg (140-67 = 73) 73 x 85 = 620573 x 85 = 6205 6205/ 73 =856205/ 73 =85 85 x 1.23 = 104.ml/min85 x 1.23 = 104.ml/min
So, 18 000 iu Dalteparin once per day as CrCl > 30ml/minSo, 18 000 iu Dalteparin once per day as CrCl > 30ml/min
Age 85 yrsAge 85 yrs
Gender – FemaleGender – Female
Ideal Weight 60KgIdeal Weight 60Kg
Cr – 160 μmol/LCr – 160 μmol/L
(140-85 = 55)(140-85 = 55) 55 x 60 = 330055 x 60 = 3300 3300 / 160 = 20.63300 / 160 = 20.6 20.6 x 1.04 =20.6 x 1.04 =
21.24ml/min21.24ml/min
So, 5000iu Dalteparin am and 5000iu Dalteparin pm as CrCl 20-29ml/minSo, 5000iu Dalteparin am and 5000iu Dalteparin pm as CrCl 20-29ml/min
If patient weighed more than 100Kg split dose if CrCl ≥30ml/minIf patient weighed more than 100Kg split dose if CrCl ≥30ml/min
42. Slow ActingSlow Acting
Slow – Vitamin K antagonistsSlow – Vitamin K antagonists
eg warfarin 5mg po odeg warfarin 5mg po od
Affects factors 2, 7, 9, 10, C and SAffects factors 2, 7, 9, 10, C and S
If started on 10mg po od can get a drop inIf started on 10mg po od can get a drop in
protein C and S (shortest acting vitamin Kprotein C and S (shortest acting vitamin K
dependent factors), which can cause adependent factors), which can cause a
hyper-coaguable statehyper-coaguable state
Takes 2-3 days to reach desired level shownTakes 2-3 days to reach desired level shown
by INR of 2-3by INR of 2-3
If any medication changes, check INR as canIf any medication changes, check INR as can
be affectedbe affected
43. PreventionPrevention
Bilateral Lower ExtremityBilateral Lower Extremity
Sequential CompressionSequential Compression
DevicesDevices
TEDs and FlowtronsTEDs and Flowtrons
When the legs areWhen the legs are
squeezed the veins release asqueezed the veins release a
factor which thins the bloodfactor which thins the blood
stopping clot formation,stopping clot formation,
the rhythmic motion copiesthe rhythmic motion copies
that of leg movementthat of leg movement
ThromboprophylaxisThromboprophylaxis
DalteparinDalteparin
44. Genetic Blood TestsGenetic Blood Tests
25-50% of patients with VTE have an inherited disorder25-50% of patients with VTE have an inherited disorder
There are genetic causes of metabolism which may be tested forThere are genetic causes of metabolism which may be tested for
- Factor V Leiden – causes increased clotting as variant cannot beFactor V Leiden – causes increased clotting as variant cannot be
inactivated by Factor Protein C (5% of popinactivated by Factor Protein C (5% of popnn
and 20% of pts withand 20% of pts with
thrombus)thrombus)
- Factor Protein C Deficiency – results in normal cleaving of FactorFactor Protein C Deficiency – results in normal cleaving of Factor
Va and Factor VIIIaVa and Factor VIIIa
- 20210 (prothrombin) Mutation – 2-3 times risk of clot formation20210 (prothrombin) Mutation – 2-3 times risk of clot formation
- MTHMFR affects regulation of homocysteineMTHMFR affects regulation of homocysteine
- Lupus anticoagulant- prothrombotic agent which can causeLupus anticoagulant- prothrombotic agent which can cause
inappropriate clottinginappropriate clotting
- Anti phospholipid antibody – confused autoimmune responseAnti phospholipid antibody – confused autoimmune response
If any of these are positive and patient has a clot then may needIf any of these are positive and patient has a clot then may need
treatment for longertreatment for longer