Page 230 - 2021 IDMT Digital

PULMONARY EMBOLISM
Introduction:
• $ SXOPRQDU\ HPEROLVP 3( RFFXUV ZKHQ D GHHS YHLQ WKURPERVLV GLVORGJHV DQG WUDYHOV
WR WKH OXQJ FDXVLQJ ORVV RI R[\JHQDWLRQ RI WKH EORRG IORZLQJ WR WKDW DUHD RI WKH OXQJ
• 3( LV D FRPPRQ VHULRXV DQG SRWHQWLDOO\ IDWDO HYHQW
• +\SHUFRDJXODELOLW\ FDQ EH FDXVHG E\ PHGLFDWLRQV GLVHDVH RU LQKHULWHG JHQH GHIHFWV
• 7KH FOLQLFDO GLDJQRVLV RI 3( LV QRWRULRXVO\ GLIILFXOW
o &OLQLFDO ILQGLQJV GHSHQG RQ ERWK VL]H RI HPEROXV DQG SDWLHQW¶V SUH-H[LVWLQJ
FDUGLRSXOPRQDU\ VWDWXV
o &RPPRQ V\PSWRPV RI 3( DUH QRW VSHFLILF
Subjective:
• 6LJQV DQG 6\PSWRPV
o $FXWH XQH[SODLQHG 62% ZLWKRXW VLJQLILFDQW RWKHU V\PSWRPV
o '\VSQHD WDFK\SQHD WDFK\FDUGLD FKHVW SDLQ ZLWK LQVSLUDWLRQ
• )RFXVHG +LVWRU\
o 5HFHQW WUDXPD
o 3URORQJHG WUDYHO RU UHVW
o 2UDO ELUWK FRQWURO RU KRUPRQH UHSODFHPHQW WKHUDS\
o +LVWRU\ RI EORRG FORWV LQ WKH IDPLO\
Objective:
• 3K\VLFDO ([DP
o 7DFK\SQHD 55 ! GHFUHDVHG R[\JHQ VDWXUDWLRQ SRVVLEOH FUDFNOHV DQG UDOHV
ZKHH]LQJ WDFK\FDUGLD DFFHQWXDWHG 6
o 0D\ EH K\SRWHQVLYH DQG DQ[LRXV
o (YLGHQFH RI '97 ± OHJ HGHPD DQG SDLQ
• 7RROV
o (&* LV DEQRUPDO LQ RI SDWLHQWV ZLWK VLQXV WDFK\FDUGLD DQG QRQ-VSHFLILF
67 DQG 7 ZDYH FKDQJHV
o 3ODVPD OHYHOV RI ' dLPHU DUH XVXDOO\ HOHYDWHG
ƒ VHQVLWLYLW\ IRU YHQRXV WKURPERHPEROLVP
Assessment:
• 'LIIHUHQWLDO
o 0\RFDUGLDO iQIDUFWLRQ GLDSKRUHVLV FKHVW SDLQ DQG (&* FKDQJHV
o 3QHXPRWKRUD[ KLVWRU\ RI WUDXPD ZLWK GHFUHDVHG EUHDWK VRXQGV
o 6HYHUH EURQFKRVSDVP ZKHH]LQJ DQG FRXJKLQJ
o 3QHXPRQLD WR[LF FOLQLFDO DSSHDUDQFH
o 3HULFDUGLWLV GLVWDQW KHDUW VRXQGV distended QHFN YHLQV

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