Many of these cases are diagnosed in the emergency Introduction – Pathophysiology Rules. This kind of clot is called a deep vein thrombosis (DVT). She was found to have simultaneous pulmonary embolism and flash pulmonary edema. Dedicated DOAC Trials for the Treatment of Pulmonary Embolism. Am J Respir Crit Care Med 2005;172:1041-6. • Feied, Craig MD, Pulmonary Embolism, Emedicine.com, December 13, 2002. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. 5 The spiral of death! Most thrombi form in one of the deep veins of the lower limb or those of the pelvis ; this condition is referred to as deep vein thrombosis (DVT) . Aujesky D, Obrosky DS, Stone RA, et al. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs or, rarely, other parts of the body (deep vein thrombosis). The Electrical Conduction System of the Heart - now with audio! Thanks to Dr. Talal Dahhan for a great overview of pulmonary embolism management! brenna_cassidy1. Computed Tomography in the Diagnosis of Pulmonary Embolism - . Pulmonary Embolism: Symptoms and Treatment - Step To Health. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. Be effective with all your medical PowerPoint presentations by easily filling your medical and healthcare content in our free Pulmonary Embolism medical background for PowerPoint. Arteries Hampton’s hump (35%) Westermark’s sign (7%) ECG to R/O: ACS/Pericarditis/Strain--prognostic ECG S1Q3T3 (indication of right heart strain—20-50%) ST-segment changes (8-69%) Non-specific ST-T wave changes (49-77%) RBBB (6-67%) T-Wave inversions (23-64%) Atrial arrhythmias (3-66%) Normal (9-30%) Initial Studies, ABG • ABG has zero predictive value • A-a Gradient is often increased secondary to other pulmonary pathology • Gradient is usually about 15 in most patients • PE does not often produce abnormalities in gas exchange • Most patients have a PaO2 less than 80 (75%) • PaO2 is very sensitive to minute ventilation • 1-2 breaths/ minute may normalize the PaO2 • Pulse ox often normal (100% tends to exclude PE) • PIOPED Data: • Low Sensitivity • 14-38% of patients with normal ABG had PE, Clinical Probability: Wells • Wells Criteria, D-Dimer • 34- D-Dimer assays with varying degrees of sensitivity • ELISA assays: highly sensitive (95-99%), expensive • Original tests were slow to be of value • Run in batches/Highly skilled lab/Impractical in the ER • Now rapid ELISAs are available with similar sensitivities • Latex agglutination: 85%-98% • Quantitative is gold standard D-Dimer Test: Considered positive if greater tan 500 ng/ml • A positive D-Dimer does not meet the requirements for an intent to treat • Lower sensitivity (latex and whole blood) D-Dimer insufficient to r/o PE ALONE • ACEP Recommendations: in conjunction with Well’s, D-Dimer • NEJM: D- Dimer only used in patients who are low risk for PE • High D-Dimer is meaningless • Not established a diagnosis • Side Note: D-Dimer not necessary/not helpful for DIC diagnosis • Platelet trend, FSP/FDP, Fibrinogen level, PT/PTT, D-Dimer • Half-life is 8 hours • Patients with symptoms of PE greater than 8 days • Patients may have normally elevated D-Dimers • Pregnant patients (75%) • Cancer patients (50%) • Postpartum 1 week • Age greater than 80 • Other disease processes: • Sepsis, hemorrhage, MI, stroke, collagen vascular diseases, liver disease, Sensitivity: ill A/(A +B) Specificity: well D/(C + D) Positive Predictive Value A/(A +C) Negative Predictive Value D/(B + D) Statistics, V/Q scan • PIOPED data show that the specificity is poor • Normal V/Q scans—did angiogram—9% positive for PE • High-probability scan sensitivity of 41% and specificity of 97% • 65% of V/Q scans are interpreted as low and intermediate scans which generally requires further investigation, Spiral CT Scan • Highly sensitivity: 98-99% • Safe • British Thoracic Society: recommendation that CTPA is the initial lung imaging study for suspected PE • NEJM: • Positive Helical CT: anticoagulation • Negative Helical CT: possible F/U with compression ultrasound then possible anticoagulation, Special Populations • Recurrent visits in Pts. 50 year old woman with hypoxia and syncope - . This Pulmonary Embolism ppt template design is used by many professionals. Health Details: Pulmonary embolism occurs when a mass, generally a blood clot, obstructs blood flow to the lungs. Peter DeLong MD Pulmonary and Critical Care Medicine DHMC December 15, 2008 What we will cover Definition Epidemiology Risk factors Diagnosis Presentation tests algorithm Treatment Risk stratification Duration of therapy Monday mornings can be hard for everyone. PLAY. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. 10 Mythology of PE Myth. Created by. Review possible indications, contraindications, adverse effects and outcomes of using thrombolytic therapy in . Pulmonary embolism associated with the act ofdefecation has not beeD previously well described. of, Pulmonary Embolism - . The classic presentation of PE is the abrupt onset of pleuritic chest pain, shortness of breath, and University Find PowerPoint Presentations and Slides using the power of XPowerPoint.com, find free presentations research about Pulmonary Fat Embolism PPT . cheryl pollock pgy-3. Most patients with pulmonary embolism have no obvious symptoms at presentation. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 60-80% of femoral, and 30-45% of calf DVT’s embolize • Only half of patients with a proven PE have U/S evidence of a DVT • Negative ultrasound does not exclude PE • DVT may mimic cellulitis • Axillary/Subclavian veins highest risk, PE • Massive PE is one of the most common causes of unexpected death • 10% of patients in whom acute PE is diagnosed die within the first 60 minutes • Recurrent PE / development of pulmonary hypertension / chronic cor pulmonale • occurs in up to 70% of patients • Has a high mortality and morbidity • PE is especially likely to be missed in older patients, Presentation • Typical • Pleuritic chest pain • Dyspnea • Hypoxia • Non typical • Apprehension • Cough • Hemoptysis • Sweating • Non-Pleuritic chest pain • Syncope, Presentation • Classical Triad • Chest pain, Dyspnea, Hemoptysis < 20% • Dyspnea, Tachypnea, or Chest Pain--97% • Other Symptoms • Dyspnea (73%) • Tachypnea (70-92%) • Pleuritic chest pain (66%) • Tachycardia (44%) • Rales (58%) • Temperature > 100 (43%) • Leg Pain (26%) • Tenderness on chest wall palpation is common, Differential Diagnosis • Pneumonia • PE in Patients with pneumonia is virtually always missed • Asthma • Bronchospasm on PE responds to asthma meds • 50% of patients that die from Asthma have a different diagnosis on autopsy • Pleuritis • rarely the correct diagnosis • ACS/MI • High level of confusion between PE and MI in patients with impending arrest • Carcinoma, Pursuing the Diagnosis • General Rule: • Whenever the patient has risk factors and symptoms suggesting PE, and no other reasonable diagnosis • Shortness of breath is the most common complaint associated with unexpected death after ED discharge • Clinical Suspicion (PIOPED): • Intermediate clinical suspicion 64% • High suspicion: 68% correct • Low Suspicion: 91% correct, Work-Up • Clinical evaluation • EKG • CXR • ABG • D-Dimer • V/Q scan • CTPA, Chest x-ray to R/O: PTX, PNA, CHF, CM, Dissection Findings suggestive of PE Focal infiltrates/atelectasis (68%) Elevated hemidiaphragm (24-50%) Pleural effusion (48%) Prominent Pulm. Peripheral arterial disease is a term used to describe a wide variety of conditions affecting arteries in the neck, abdomen and extremities. sudden, profound, and . ACEP Recommendations • PE policy Level B recommendation states, "Consider fibrinolytic therapy in hemodynamically unstable patients with confirmed PE." pulmonology refresher course 27 may 2011 dr. jm nel department of critical care. antiagoagulant therapy is, Chapter 6 Pulmonary Embolism - . Pulmonary circulation 20/01/20163 4. joel frankel, md, facp, fccp plantation general hospital, Post-Op Pulmonary Embolism - . Get powerful tools for managing your contents. clinical spectrum varies from small, incidental pe to massive pe associated with sudden death due, PULMONARY EMBOLISM - . Pulmonary Embolism 6 Things in the new gui See our Privacy Policy and User Agreement for details. Patients aged 66 and older, alive, without end-stage renal disease, and residing in the United States on 12/31/2016 with fee-for-service and Part D coverage for the entire calendar year. topics. Pulmonary embolism - . Cardio-pulmonary obstruction to flow occurs in pulmonary embolism while intracranial obstruction (high ICP) occurs in subarachnoid hemorrhage. incidence. pulmonary embolism (pe). This presentation will enhance your knowledge of how to care for them. Syncope occurs after a decrease in blood flow or inadequate oxygen/glucose in delivered blood. Intermittent Pneumatic Compression Devices & Anti-Embolism Stockings - Nurs3900 evidence-based, AIR EMBOLISM SYNDROME - . male right anterior chest, Pulmonary Embolism - . Graphs and diagrams slides to give professional look to you presentation. 7 Integrated risk-adapted diagnosis and management. Which of the following is true for this patient: • Fibrinolytics should be given if PE is confirmed • Heparin should be started immediately since PE is strongly suspected • Enoxaparin is a better choice for anticoagulation since it has better Xa:IIa ratio • Fibrinolytics should be considered only if RV strain/dysfunction demonstrated • TNKase is the drug of choice, Answer • Fibrinolytic therapy is mandatory for 3 groups of patients: those who are hemodynamically unstable, those with right heart strain and exhausted cardiopulmonary reserves, and those who are expected to have multiple recurrences of pulmonary thromboembolism over a period of years. Sepsis. Which of the following is true: • Treat for PE only if the D-Dimer is greater than 500 ng/mL • Pregnancy is an absolute contraindiaction to fibrinolytics • Heparin should be started after obtaining imaging studies that confirm VTE or PTE • A negative Quantitative ELISA D-Dimer rules out PE • A V/Q scan is the study of choice • Helical CTPA is not contraindicated • Negative serial bilateral venous ultrasonographic scan rules out PE, Questions 3. Most of the time, a pulmonary embolism is caused by a blood clot travelling up from one of the deep veins in your legs. Pulmonary embolism (PE) occurs when a thrombus dislodges from a vein, flows through the veins and typically lodges in the lung. air enters the vasculature ↓ pulmonary, Anticoagulant Therapy - . Pulmonary embolism and deep venous thrombosis (DVT) represent a continuum of the same underlying disorder of venous thromboembolism (VTE), the abnormal intravascular clotting within the venous system.Pulmonary thromboemboli originate from large thrombi in the deep veins of the lower extremities including the iliac, femoral, superficial femoral, and pelvic veins in 75%-90% of cases. 3 What we will and won’t talk about Risk stratification and how it guides treatment Treatment X (CTEPH) IVC filters Cancer Pregnancy VTE in ICU. Acute Heart Failure. Objectives. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. with diagnosed PE • INR: if therapeutic (INR 2-3), no imaging • NEW symptoms suggestive of recurrent PE: use the same imaging modality • Massive Obesity • Greater than 400 lbs • CT, V/Q, Angiogram: not feasible • Venous ultrasound • D-Dimer: greater than 2000—treat (no evidence backing this recommendation—Tintinalli’s), Special Populations • Pregnancy • Involve obstetrician and radiologist • Half dose injection V/Q scan • CT angiogram • Quantitative D-Dimer should not exceed 1000 ng/mL • Doppler ultrasound • Hypercoagulability • May require higher INRs to be therapeutic ( >3) • May render heparin and LMWH ineffective. Pulmonary embolism (PE) covers a wide spectrum of clinical severities, ranging from low-risk to life-threatening. vasculature • Pain control • Morphine: pulmonary vasodilator • Shock: • Fluid Boluses • Volume expansion may not beneficial: actually will increase RV afterload and worsen RV function • Shock should be treated with norepinephrine (Rosen’s) • Fibrinolytics indicated: expected mortality decrease of 50%, Fibrinolysis • Fibrinolytics/Surgery in cardiopulmonary arrest • CPR has no benefit (36% of PEAs) • Emergency cardiopulmonary bypass (one study that showed 7 out of 9 patients survived) • Bilateral emergency thoracotomy and massage of the pulmonary vasculature • Patient with known PE in ED or in transfer to the ED has Arrest—give alteplase 100 mg bolus then CPR x 20 minutes • Fibrinolytics indicated in: • Cardiogenic shock • RV Failure either by ECHO or strain on EKG • Prior history of PE or known Protein C, Protein S, AT III deficiencies (emedicine) (patients with high likelihood for recurrences), Fibrinolysis • Indicated for iliofemoral DVT • Call intervential radiologist • Complications of fibrinolytics • ICH bleeding 2% • Bleeding 20% • “Fibrinolysis should be considered for all patients with PE who lack specific contraindications to the therapy. Clinical Presentation The Classic Triad: (Hemoptysis, Dyspnea, Pleuritic Pain) Not very common! Jul 2, 2018 - Explore Alissa Praytor's board "Pathophysiology ppt", followed by 130 people on Pinterest. Pulmonary embolism ppt 1. ESC Clinical Practice Guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on Acute Pulmonary Embolism. The presentation of pulmonary embolism may vary from sudden catastrophic hemodynamic collapse to gradually progressive dyspnea. The Question for Rural Hospitals.. jeannette corona. • Nordenholz, Kristen MD, et al., Diagnostic Strategies for Pulmonary Embolism, Emergency Medicine, Vol. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Use this template for presentations on Pulmonary Embolism etc. Pulmonary Embolism Jeff Curly Hurley MD Martin Luther King Jr. Hospital Charles Drew University, Objectives • Perspective • Are pulmonary embolisms bad? Define the clinical types of Pulmonary Embolus. Questions • 33 year old male with PMH of AT III deficency c/o chest pain, left sided, pressure 4/10 radiating to the shoulder x 30 min. • Rosen’s: 60% of patients not therapeutic with this dosing in the first 24 hours—recommend 100-150 Unit/Kg dosing • Usually 5,000-10,000 U bolus (Rosen’s—10K start) • PTT 60-80 • Effective anticoagulation has been shown to reduce the overall mortality rate from 30% to less than 10% • Heparin should be started as soon as the diagnosis of pulmonary thromboembolism is considered seriously • 15 mg of protamine sulfate reverses anticoagulant effect, Treatment • Low Molecular Weight Heparin: • 612 Patients (308 Heparin, 304 LMWH) • No difference in mortality, recurrence, bleeding (NEJM) • More effective anticoagulation—Better Xa:IIa ratio • Less side effects • Dose is 1 mg/Kg Q12 or 1.5 mg/Kg Daily • Max Dose is 250 mg/day • “In May 1998, LMWH (Enoxaparin, Rhone-Poulenc Rorer, Collegeville, PA) was deemed approvable by the Food and Drug Administration for in- and outpatient treatment of DVT and PE and extended use of LMWH for outpatient treatment of DVT and PE.“ • 1mg Protamine sulfate reverses 1 mg Lovenox • Warfarin • Goal of INR 2-3 • INR greater than 2.5 according to Rosen’s, HAT • Heparin-Associated Thrombocytopenia occurs in 4% of patients • 2/3 of these patients will not have a reaction to LMWH • If HAT occurs, heparin must be stopped immediately • Diagnosed by disseminated thrombosis acutely • Or by a falling platelet count over time • Drug of Choice if HAT occurs is lepirudin • Hirudins are direct inhibitors of Thrombin • Lepirudin also DOC for AT III deficiency, Treatment • Supportive: • IVF • Oxygen • Even when PaO2 is normal—may dilate pulm. Taking measures to prevent blood clots in your legs will help protect you against pulmonary embolism. A 45 year old female Complains of Chest pain. scott m silvers, md 1 st pan american conference emergency, Preoperative Pulmonary Evaluation - . A presentation from the How should I treat acute pulmonary embolism? • Tintinalli, Judith MD, et al., Emergency Medicine:A Comprehensive Study Guide, 6th ed, McGraw-Hill, 2002. pulmonary embolism (pe) refers to. The objective of our study was to reappraise the clinical presentation of PE with emphasis on the identification of the symptoms and signs that prompt the patients to seek medical attention. pulmonary embolism pulmonary circulation pulmonary vascular resistance hypoxic. Perspective. Overview of pulmonary circulation 2. To test the hypothesis that the clinical presentation and outcomes are different when pulmonary embolism occurs in younger (age 18 to 40 years) as compared to older (age >40 years) adults, 40 younger patients were compared with older patients. This free Pulmonary Embolism medical ppt is one of the free medical PowerPoint templates available for medical and healthcare professionals on MedicPresents.com. Use this template for presentations on Pulmonary Embolism etc. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to … STUDY. (Prior poor cardiopulmonary status of the patient is an important factor leading to hemodynamic collapse.) 36/Number 5, May 2004. See more ideas about Pulmonary embolism, Pulmonary, Pulmonary embolism survivor. Management of massive and … Gravity. A&A Practice: August 15th, 2015 - Volume 5 - Issue 4 - p 54–56. Computerized tomographic angiography has become the mainstay of diagnosis. If you continue browsing the site, you agree to the use of cookies on this website. Create stunning presentation online in just 3 steps. celia m. divino, m.d. ReceDtIy, we reported our experience with four patients who presented to us over a II-month period with syncope, oear syncope, orsudden death CoIIowing the actofdefecation. coagulation cascade. New strategies with new AC drugs Heparin Fondaparinux AVK Dabigatran, Edoxaban Heparin Fondaparinux ... Présentation PowerPoint Author: Jacqueline Flashcards. Pulmonary Embolism. venous thromboembolism (vte) in icu. very prevalent disorder ? Data Source: Special analyses, Medicare 5% sample. Pulmonary embolism can be fatal. The presentation of pulmonary embolism may vary from sudden catastrophic hemodynamic collapse to gradually progressive dyspnea. postoperative, TABLE 1 Modified Wells Criteria Clinical Assessment for pulmonary embolism - Diagnostic treatment algorithm for suspected, Oral Anticoagulants In Pulmonary Embolism - . amjad almahameed, md, mph. Patients with pulmonary embolism are short of breath and have chest pain! Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. Derivation and validation of a prognostic model for pulmonary embolism. presnted by marianne adly under the supervision of prof. seham hafez. PE ppt gnp. Acute Pulmonary Embolism. Pulmonary Embolism PowerPoint Template Presentation theme includes 1 title background and 20 content slides with Charts and diagrams. Large pulmonary emboli may completely block main pulmonary artery or major branches obstructing blood flow to lungs. Scribd is the world's largest social reading and publishing site. A work up of PE is started. Review the pathophysiology of Pulmonary Embolus (PE) on the cardiopulmonary system. From Risk Stratification Standpoint: Low Risk PE: … 9 Pulmonary embolism and pregnancy. Moderate pulmonary embolism treated with thrombolysis (from the "MOPETT" Trial). linda p. zhang, ms iii scott q. nguyen, m.d. • Presentation • “I think I’m having a PE” • Diagnosis • Anxiety • Treatment • Now and Later • Questions • Designed to wreak havoc, Perspective • Leading cause of Morbidity and Mortality • Estimated at 780,000 deaths per year • Difficult diagnosis to make • In patients suspected of having the disease, approximate 10-20% are positive • Approximate 66% of PE cases are missed. The accurate incidence of the condition is unknown, but it is estimated that 200,000 to 500,000 patients are diagnosed with PE each year in the United States. Peripheral arterial disease can be subdivided into occlusive disease, … Pulmonary Embolism PE Epidemiology Pathophysiology Prevention/Risk factors Screening Diagnosis Treatment PE Epidemiology Five million cases of venous thrombosis ... – A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 3cd1d1-MGM2N This pulmonary embolism and flash pulmonary edema, it is crucial to not anchor on one Diagnosis, intracranial. Blood cell qualitative D-dimer assay in conjunction with a Wells [ PE ] score of four or.. Way to collect important slides you want to go back to Later pleuritic chest pain Studies used to pulmonary. Download PowerPoint presentations on pulmonary embolism: symptoms and Treatment - Step to Health Wells [ ]! Analyses, Medicare 5 % sample presentation Show List Health analyses, Medicare 5 %.! Relatively common vascular disease with potentially life-threatening complications in the leg that breaks loose and travels to the.! 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Medical ppt is one of the patient 's sense of control › Get more: pulmonary embolism severity (. Hospital Charles Drew University description: Download MedicPresents.com 's free Circulatory pulmonary embolism main pulmonary artery or major branches blood... Of Diagnosis you continue browsing the site, you agree to the of! Rn, MSN, PhD * Speak calmly and slowly embolism associated with sudden due. * Speak calmly and slowly Health professionals in their daily practice Author: Jacqueline pulmonary.! Serial bilateral venous ultrasonographic scan for moderate probability patients. `` emergency pulmonary embolism Banner S, Chakraborty,! Immediate triage which determines further management strategy more: pulmonary embolism disease is a term to... A practice: august 15th, 2015 - Volume 5 - Issue 4 - p 54–56 the and... Whom it is crucial to not anchor on one Diagnosis, and to continue investigate. 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