Obligatory medical device diagnostics. Electrocardiogram (ECG; recording of the electrical activities of the myocardium)* – as an emergency baseline diagnostic[excessive P wave (P pulmonale), a right deviation of position type, right heart strain sign (new onset right bundle branch block), S-I Q-III type, T negatives in V1-V4 (5), ST depressions; atrial arrhythmias] Blood pressure measurement … Pulmonary Embolism: Diagnostic Tests
In principle, the following measures are available for the acute therapy of pulmonary embolism: Anticoagulation (anticoagulation; NOAK: apixaban, dabigatran, edoxaban, and rivaroxaban) or intravenous thrombolysis (dissolving the thrombus) as an emergency measure in case of hemodynamic deterioration (ESC guideline: class 1 recommendation). Recanalizing procedures (reopening of displaced vessels): thrombectomy (surgical removal of a blood clot … Pulmonary Embolism: Surgical Therapy
To prevent pulmonary embolism, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Inadequate fluid intake – leads to desiccosis (dehydration), thus increasing thrombophilia (tendency to clot/thrombosis) Consumption of stimulants Tobacco (smoking) Physical activity Frequent prolonged sitting or immobility (bedriddenness). Prolonged sitting in front of the TV – ≥ 5 h/d … Pulmonary Embolism: Prevention
The following symptoms and complaints may indicate pulmonary embolism: The symptom pattern depends on the size of the thrombus! If a massive pulmonary embolism occurs (i.e., obstruction of more than 50% of the pulmonary circulation; in approximately 5-10 of all cases of pulmonary embolism), then the full clinical picture of pulmonary embolism described below is … Pulmonary Embolism: Symptoms, Complaints, Signs
Pathogenesis (development of disease) Approximately 80-90% of thrombi in the pulmonary arteries originate from deep vein thrombosis (TBVT) and 10-20% from thrombosis of the iliac, axillary, jugular veins or from the right heart. If a thrombus (blood clot) detaches from its association, it closes via the heart into a pulmonary artery and then relocates a … Pulmonary Embolism: Causes
General measures Immobilization – not for severity level 1 Early discharge and outpatient therapy in “carefully selected” low-risk patients may be considered if subsequent anticoagulation is warranted on an outpatient basis (Class IIa recommendation). After the acute phase: Nicotine restriction (refraining from tobacco use). Review of permanent medication due topossible effect on the existing disease. … Pulmonary Embolism: Therapy
1st order laboratory parameters – obligatory laboratory tests. Small blood count [for basic diagnosis; if unfractionated heparin (UFH) is used, regular check of platelet count]. CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Blood gas analysis (BGA) D-dimer (end product of proteolysis of fibrin) – Indications: in suspected pulmonary embolismNote: The specificity (probability that actually … Pulmonary Embolism: Test and Diagnosis
Therapeutic targets Dissolution of the thrombus (thrombolysis/dissolution of the thrombus). Secondary prophylaxis (measures intended to prevent further progression of a disease that has already occurred; see below). Therapy recommendations 2019 ESC Guidelines:Anticoagulation treatment should be given as soon as pulmonary embolism is suspected, if there is a moderate or high clinical probability, without waiting for … Pulmonary Embolism: Drug Therapy
Medical history (history of illness) represents an important component in the diagnosis of pulmonary embolism. Family history Is there a history of frequent cardiovascular disease in your family? Social history What is your profession? Do you sit a lot? Have you just taken a long-haul flight? Current medical history/systemic history (somatic and psychological complaints). Have … Pulmonary Embolism: Medical History
Respiratory System (J00-J99) Bronchial asthma Bronchitis – inflammation of the bronchi. Pleurisy (inflammation of the pleura) Pneumonia (pneumonia) Pneumothorax – usually an acute clinical picture in which air enters the pleural space and thus obstructs the expansion of one or both lungs. This leads to the fact that the respiration is not or only limited … Pulmonary Embolism: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by pulmonary embolism: Respiratory system (J0-J99) Infarct pneumonia – pneumonia that manifests in the portion of the lung that is no longer perfused. Lung abscess – formation of an encapsulated collection of pus. Pleurisy (inflammation of the pleura) Pleural effusion – … Pulmonary Embolism: Complications
Staging of pulmonary embolism (LE) according to Grosser. Severity I moderately severe LE Severity II severe LE Severity III massive LE Severity IV fulminant LE Clinical symptoms Discrete (sudden, short-term onset of dyspnea (shortness of breath), hyperventilation, anxiety, and dizziness), clinically silent in 80% Acute dyspnea, tachypnea (respiratory rate: > 20/min), tachycardia (heart beats: > … Pulmonary Embolism: Classification
