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Latest & greatest articles for pulmonary embolism
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CRACKCast E088 – PulmonaryEmbolism & Deep Venous Thrombosis CRACKCast E088 - PulmonaryEmbolism & Deep Venous Thrombosis - CanadiEM CRACKCast E088 – PulmonaryEmbolism & Deep Venous Thrombosis In , by Adam Thomas June 29, 2017 This episode of CRACKCast covers Rosen’s Chapter 88, DVT and PE. This episode covers the risk factors, diagnostic approach, treatment and management of PEs and DVTs. Shownotes – Rosen’s in Perspective This chapter is all about VTE – venous thromboembolism (...) discussion) Fondaparinux Apixaban Rivaroxaban OR heparin infusion after a loading bolus Ideally transition to oral anticoagulation at least 3 months (some up to 12 months) Encourage ambulation as much as possible Bedrest promotes DVT extension, risk of embolization, and post-DVT syndrome 8) What are the common causes of upper limb DVT? Upper limb DVT = thrombosis in the axillary vein “ The deep veins of the upper extremity include the paired ulnar, radial and interosseous veins in the forearm, paired
The Risk of Deep Venous Thrombosis and PulmonaryEmbolism in Primary Sjogren Syndrome: A General Population-based Study To estimate the future risk and time trends of venous thromboembolism (VTE) in individuals with newly diagnosed primary Sjögren syndrome (pSS) in the general population.Using a population database that includes all residents of British Columbia, Canada, we created a study cohort of all patients with incident SS and up to 10 controls from the general population matched for age (...) , sex, and entry time. We compared incidence rates (IR) of pulmonaryembolism (PE), deep vein thrombosis (DVT), and VTE between the 2 groups according to SS disease duration. We calculated HR, adjusting for confounders.Among 1175 incident pSS cases (mean age 56.7 yrs, 87.6% women), the IR of PE, DVT, and VTE were 3.9, 2.8, and 5.2 per 1000 person-years (PY), respectively; the corresponding rates in the comparison cohort were 0.9, 0.8, and 1.4 per 1000 PY. Compared with non-SS individuals
Simplified diagnostic management of suspected pulmonaryembolism (the YEARS study): a prospective, multicentre, cohort study. Validated diagnostic algorithms in patients with suspected pulmonaryembolism are often not used correctly or only benefit subgroups of patients, leading to overuse of computed tomography pulmonary angiography (CTPA). The YEARS clinical decision rule that incorporates differential D-dimer cutoff values at presentation, has been developed to be fast, to be compatible (...) with clinical practice, and to reduce the number of CTPA investigations in all age groups. We aimed to prospectively evaluate this novel and simplified diagnostic algorithm for suspected acute pulmonary embolism.We did a prospective, multicentre, cohort study in 12 hospitals in the Netherlands, including consecutive patients with suspected pulmonaryembolism between Oct 5, 2013, to July 9, 2015. Patients were managed by simultaneous assessment of the YEARS clinical decision rule, consisting of three items
Update: D-dimer Test for Excluding the Diagnosis of PulmonaryEmbolism TAKE-HOME MESSAGE Patients with a low pretest probability for pulmonaryembolism according to a structured clinical prediction rule and a negative D-dimer result are unlikely to have pulmonaryembolism, particularly among those younger than 65 years. Update: D-dimer Test for Excluding the Diagnosis of PulmonaryEmbolism EBEM Commentators Daniel Kwon, BS Lake Erie College of Osteopathic Medicine Erie, PA Melody Milliron, DO (...) -dimer test. Finally, the review is not able to answer questions about the ability of D-dimer to assess for pulmonaryembolism in pregnant patients. Appropriate use of advanced radiographic imaging has been highlighted through national effortssuchastheChoosingWisely campaign, which aims to improve patient care by avoiding wasteful or unnecessary medical tests, treatments,andprocedures. 3 Using a negative D-dimer test result for patients with low pretest probability based on a clinical decision rule
The use of veno-venous extracorporeal membrane oxygenation following thrombolysis for massive pulmonaryembolism A 59-year-old man was diagnosed with a massive pulmonaryembolism. Despite thrombolysis there were two episodes of cardiac arrest and following recovery of spontaneous circulation profound cardiorespiratory failure ensued. An extracorporeal membrane oxygenation retrieval team initiated veno-venous extracorporeal membrane oxygenation on site to facilitate transfer (...) to the extracorporeal membrane oxygenation centre. An excellent outcome is reported in the short term. This represents one of the few published cases of veno-venous extracorporeal membrane oxygenation for a massive pulmonaryembolism following thrombolysis.
Age-adjusted D-Dimer to Exclude PulmonaryEmbolism Emergency Medicine > Journal Club > Archive > February 2016 Toggle navigation February 2016 Age-adjusted D-Dimer to Exclude PulmonaryEmbolism Vignette You are working in a community ED one afternoon when you encounter Mrs. X, a pleasant 65-year old woman with a history of hypertension and osteoporosis, who is in town visiting her grandchildren from California. She flew in 2 days earlier, and for the last 12 hours has noted some right-sided (...) in additional confirmatory testing (CT, VQ scan). Search Strategy PubMed was searched using the terms "age adjusted d-dimer" ( ). This resulted in 148 articles, from which the following 4 were selected. Article 1: Article 2: Article 3: Article 4: Bottom Line In patients who are not high-risk for pulmonaryembolism, D-dimer has been shown to be effective at ruling out disease. Unfortunately, this test also has a low specificity and a high false-positive risk. This risk increases (and specificity decreases
Imaging for the exclusion of pulmonaryembolism in pregnancy. Pulmonaryembolism is a leading cause of pregnancy-related death. An accurate diagnosis in pregnant patients is crucial to prevent untreated pulmonaryembolism as well as unnecessary anticoagulant treatment and future preventive measures. Applied imaging techniques might perform differently in these younger patients with less comorbidity and altered physiology, who largely have been excluded from diagnostic studies.To determine (...) the diagnostic accuracy of computed tomography pulmonary angiography (CTPA), lung scintigraphy and magnetic resonance angiography (MRA) for the diagnosis of pulmonaryembolism during pregnancy.We searched MEDLINE and Embase until July 2015. We used included studies as seeds in citations searches and in 'find similar' functions and searched reference lists. We approached experts in the field to help us identify non-indexed studies.We included consecutive series of pregnant patients suspected of pulmonary
Aplastic anemia and risk of deep vein thrombosis and pulmonaryembolism: A nationwide cohort study Deep vein thrombosis (DVT) and pulmonaryembolism (PE) constitute venous thromboembolism (VTE), which is not fully known in aplastic anemia (AA). Therefore, we investigated the incidence and risk of VTE in AA patients.We conducted a nationwide cohort study to investigate the risk of DVT and PE in patients with AA. We identified patients with newly diagnosed AA as the AA cohort between 2000
PulmonaryEmbolism Diagnosis and Treatment ? 2017 Kaiser Foundation Health Plan of Washington. All rights reserved. 1 PulmonaryEmbolism Diagnosis & Treatment Guideline Background 2 Evaluation and Diagnosis Adults 3 Pregnant women 4 Adults with cancer 5 Choice of Treatment Setting 6 Subsegmental PE: Treatment Versus Surveillance 8 Treatment with Anticoagulation Medications 9 Recommended testing 9 Choice of anticoagulant medications by population 9 Dosing of anticoagulant medications 11 Duration (...) guideline was developed by Kaiser Permanente Washington (KPWA). 2 Background Pulmonaryembolism (PE) is a relatively common vascular disease with potentially life-threatening complications in the short term. 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. Many of these cases are diagnosed in the emergency department (White 2016). Traditionally, patients with PE are treated in the hospital
Deep Vein Thrombosis in Patients with PulmonaryEmbolism: Prevalance, Clinical Significance and Outcome Deep venous thrombosis (DVT) and pulmonaryembolism (PE) are considered as similar disease entities representing different clinical manifestations. The objectives of this study were: 1) to determine the prevalence and outcome of DVT in patients with PE; 2) to identify additional risk factors for PE-related unfavorable outcome and 30-day all-cause mortality; and 3) to establish the clinical
Subacute right heart failure revealing three simultaneous causes of postâ€embolicpulmonary hypertension in metastatic dissemination of breast cancer A 72-year-old woman with history of breast cancer only treated surgically was referred to our department for pulmonary hypertension (PH) suspicion. Echocardiogram revealed elevated right ventricular systolic pressure. Computed tomography (CT) angiogram showed no pulmonaryembolism (PE), but lung scan revealed two ventilation-perfusion mismatch (...) areas. Right cardiac catheterization established precapillary PH. Despite treatment with PH specific therapy (sildenafil, ambrisentan, and epoprostenol), her condition worsened rapidly with acute right heart failure (RHF). She died 22 days after admission. Post-mortem microscopic examination showed a rare combination of PH etiologies consistent with metastasis of breast cancer in pulmonary vasculature including the rare pulmonary tumour thrombotic microangiopathy (PTTM).
Risk stratifying emergency department patients with acute pulmonaryembolism: Does the simplified PulmonaryEmbolism Severity Index perform as well as the original? The PulmonaryEmbolism Severity Index (PESI) is a validated prognostic score to estimate the 30-day mortality of emergency department (ED) patients with acute pulmonaryembolism (PE). A simplified version (sPESI) was derived but has not been as well studied in the U.S. We sought to validate both indices in a community hospital
The High Risk of Contrast-induced Nephropathy in Patients with Suspected PulmonaryEmbolism Despite Three Different Prophylaxis: A Randomized Controlled Trial The objective was to compare the protective effects of N-acetylcysteine (NAC) plus normal saline (NS), sodium bicarbonate (NaHCO3 ) plus NS, and NS alone in the prevention of contrast-induced nephropathy (CIN) after computed tomography pulmonary angiography (CTPA) in emergency patients.This study was planned as a randomized, controlled (...) clinical research. Patients undergoing contrast-enhanced CTPA on suspicion of pulmonaryembolism (PE) in the emergency department and with at least one risk factor for development of CIN were included in one of three different prophylaxis groups. The groups received 3 mL/kg intravenous (IV) NAC+NS or NaHCO3 +NS solution or NS alone 1 hour before CTPA and 1 mL/kg IV per hour for a minimum of 6 hours after CTPA. CIN was evaluated as the primary outcome and moderate or severe renal insufficiency
Acute pulmonaryembolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model The European Society of Cardiology (ESC) has proposed an updated risk stratification model for death in patients with acute pulmonaryembolism based on clinical scores (PulmonaryEmbolism Severity Index (PESI) or simplified PESI (sPESI)), right ventricle dysfunction (RVD) and elevated serum troponin (2014 ESC model).We assessed the ability of the 2014 ESC model to predict 30-day (...) death after acute pulmonaryembolism. Consecutive patients with symptomatic, confirmed pulmonaryembolism included in prospective cohorts were merged in a collaborative database. Patients' risk was classified as high (shock or hypotension), intermediate-high (RVD and elevated troponin), intermediate-low (RVD or increased troponin or none) and low (sPESI 0). Study outcomes were death and pulmonaryembolism-related death at 30 days.Among 906 patients (mean±sd age 68±16, 489 females), death
Addendum to Optimal Strategies for the Diagnosis of Acute PulmonaryEmbolism: A Health Technology Assessment – Project Protocol Addendum to Optimal Strategies for the Diagnosis of Acute PulmonaryEmbolism: A Health Technology Assessment – Project Protocol | CADTH.ca CADTH Document Viewer Addendum to Optimal Strategies for the Diagnosis of Acute PulmonaryEmbolism: A Health Technology Assessment – Project Protocol Table of Contents Search this document Addendum to Optimal Strategies (...) for the Diagnosis of Acute PulmonaryEmbolism: A Health Technology Assessment – Project Protocol October 2016 Ethics Review This protocol was written a priori and will be followed throughout the review process. There are two broad normative questions to consider regarding diagnosis of acute pulmonaryembolism (PE): Should we provide diagnosis of acute PE? If yes, which strategies should be provided, and how best should those strategies be provided to diagnose those with acute PE? Both of these questions