Ebook Revision notes for the respiratory medicine specialty certificate examination: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội 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 thromboembolism, 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 2lity, occult malignancy, thrombotic disorders, long distance travel, raised BMI.Clinical findings (in order of decreasing prevalence)•Symptoms: dyspnoEbook 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 (DChapterPULMONARY 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 excluded.♦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 2aging; if negative. PE is reliably excluded.♦Isotope lung scanning may be used for initial imaging if:■facilities are available on site. CXR is normalEbook 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 imagChapterPULMONARY 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 2s•Haemodynamic compromise: shock, hypotension (systolic blood pressure <90 mmHg or sustained drop in systolic blood pressure >40 mmHg).•RV dysfunctionEbook 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 2hrombolysis 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), postoperativeChapterPULMONARY VASCULAR DISEASEPulmonary embolism (PE)Risk factors•Major (relative risk 5-20): recent surgery (abdominal/orthopaedic), postoperativeGọi ngay
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