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Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2

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Nội dung chi tiết: Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2

Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2

ChapterPULMONARY VASCULAR DISEASEPulmonary embolism (PE)Risk factors•Major (relative risk 5-20): recent surgery (abdominal/orthopaedic), postoperative

Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2e ITU, late pregnancy/puerperium. Caesarean section, lower limb fracture, varicose veins, malignancy (abdominal/pelvic/metastatic). previous thromboem

bolism, immobility.•Minor (relative risk 2—4): congenital heart disease, cardiac failure, hypertension, oestrogen supplementation, neurological disabi Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2

lity, occult malignancy, thrombotic disorders, long distance travel, raised BMI.Clinical findings (in order of decreasing prevalence)•Symptoms: dyspno

Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2

ea, pleuritic pain, subcostal pain, cough, haemoptysis, syncope.•Signs: tachypnoea (s20/min), tachycardia (>100/min), clinical deep vein thrombosis (D

ChapterPULMONARY VASCULAR DISEASEPulmonary embolism (PE)Risk factors•Major (relative risk 5-20): recent surgery (abdominal/orthopaedic), postoperative

Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2 Respiratory scoring systems and statistics).•D-dimer:♦Perform only if low or intermediate clinical probability of PE:■If negative. PE is reliably exc

luded.♦False positives with sepsis, neoplasia, inflammation, trauma, pregnancy, etc.•Imaging:♦CT pulmonary angiogram (CTPA) recommended for initial im Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2

aging; if negative. PE is reliably excluded.♦Isotope lung scanning may be used for initial imaging if:■facilities are available on site. CXR is normal

Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2

, there is no concurrent cardiopulmonary disease, standardized reporting criteria are used, a non-diagnostic result is always followed by further imag

ChapterPULMONARY VASCULAR DISEASEPulmonary embolism (PE)Risk factors•Major (relative risk 5-20): recent surgery (abdominal/orthopaedic), postoperative

Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2ent in 25-50% with DVT/PE) in those aged <50 years with recurrent PE, or those with a strong family history.•Investigations for occult cancer are only

indicated if there is a clinical suspicion.Reference: Br itish Thoracic Society Guidelines 2003.62PULMONARY VASCULAR DISEASEPoor prognostic indicator Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2

s•Haemodynamic compromise: shock, hypotension (systolic blood pressure <90 mmHg or sustained drop in systolic blood pressure >40 mmHg).•RV dysfunction

Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2

: RV dilatation, hypokinesis or pressure overload on cardiac imaging, raised brain natriuretic peptide (BNP), raised right heart pressures at cardiac

ChapterPULMONARY VASCULAR DISEASEPulmonary embolism (PE)Risk factors•Major (relative risk 5-20): recent surgery (abdominal/orthopaedic), postoperative

Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2injury:♦In patients with none of these features, mortality is <1%.Treatment•First line:♦Give heparin to patients with intermediate or high probability

of PE.♦Low-molecular-weight heparin is preferred to unfractionated heparin except in haemodynamic compromise or where rapid reversal may be needed.♦T Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2

hrombolysis is first-line treatment if there is haemodynamic compromise: Alteplase so mg bolus IV.

ChapterPULMONARY VASCULAR DISEASEPulmonary embolism (PE)Risk factors•Major (relative risk 5-20): recent surgery (abdominal/orthopaedic), postoperative

ChapterPULMONARY VASCULAR DISEASEPulmonary embolism (PE)Risk factors•Major (relative risk 5-20): recent surgery (abdominal/orthopaedic), postoperative

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