PLAY. Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. A 45 year old female Complains of Chest pain. Am J Respir Crit Care Med 2005;172:1041-6. Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. Get powerful tools for managing your contents. • A negative serial bilateral venous ultrasonographic scan for moderate probability patients.". You can change your ad preferences anytime. Am J Cardiol 2013;111:273-7. Special thanks to Dr. Scott Solomon, Professor of Medicine at Harvard Medical School for your awesome Illustrative Case Presentation at the 2012 ASE Scientific Sessions – your presentation really helped explain and demonstrate pulmonary embolism in echocardiography! hypotension, hypoxaemia, and . Pulmonary embolism (PE) occurs when a thrombus dislodges from a vein, flows through the veins and typically lodges in the lung. ... culture and treat appropriately Pulmonary edema- caused by rapid infusion Pulmonary embolism - Caused by any free floating substances that require thrombolytic therapy for several months. Presentation Summary : Embolism… Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, haemoptysis, syncope, hypotension, and shock. Although a blood clot is the most common trigger, other culprits could be a fat or air embolism. of, Pulmonary Embolism - . She was found to have simultaneous pulmonary embolism and flash pulmonary edema. Normal physical examinations were more common (58 vs 28 percent, p = 0.01) … Perspective Are pulmonary embolisms bad? 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. 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. 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. In most cases, pulmonary embolism is caused by a blood clot in the leg that breaks loose and travels to the lungs. Derivation and validation of a prognostic model for pulmonary embolism. Displaying amniotic fluid embolism PowerPoint Presentations Amniotic Fluid Embolism Pain Free Partha PPT Presentation Summary : Amniotic fluid embolism (AFE) is a catastrophic obstetric emergency . 27 y.o. PE ppt gnp. Now customize the name of a clipboard to store your clips. Jeff Curly Hurley MD Martin Luther King Jr. Hospital Charles Drew University. lucas faulkenberry m4. heart disease; VTE/PE, venous thromboembolism and pulmonary embolism. celia m. divino, m.d. pulmonology refresher course 27 may 2011 dr. jm nel department of critical care. Objectives. PowerPoint Presentation Author: Petrie, Fiona M. Last modified by: Petrie, Fiona M. Created Date: 1/1/1601 12:00:00 AM Document presentation format: On-screen Show (4:3) Other titles: Arial Palatino Linotype Times New Roman Default Design Pneumothorax What is a pneumothorax? Presentation “I think I’m having a PE” Diagnosis Anxiety Treatment Now and Later Questions Designed to wreak havoc. Syncope occurs after a decrease in blood flow or inadequate oxygen/glucose in delivered blood. Oct 21, 2013 - Pulmonary Embolism PowerPoint Template comes with different editable charts. • Emedicine.com, Questions 2. Upon literature review, there were few reports of concomitant pulmonary embolism and flash pulmonary edema. • A negative single bilateral venous ultrasonographic scan for low-probability patients. venous thromboembolism (vte) in icu. Aujesky D, Obrosky DS, Stone RA, et al. www.anaesthesia.co.in [email protected]. See our User Agreement and Privacy Policy. Large pulmonary emboli may completely block main pulmonary artery or major branches obstructing blood flow to lungs. Download Pulmonary PowerPoint templates (ppt) and Google Slides themes to create awesome presentations. journal article. [1] Patients with low-risk PE are characterised by a normal blood pressure, normal biomarkers and no right ventricular dysfunction. This kind of clot is called a deep vein thrombosis (DVT). Circulatory Pulmonary Embolism ppt template can also be used for topics like biology,tissue,embolus,deep,thrombus,shortness,healthcare,artery, etc. Because the clots block blood flow to the lungs, pulmonary embolism can be life-threatening. editabletemplates.com's Circulatory Pulmonary Embolism presentation templates are available with charts & diagrams and easy to use. The Electrical Conduction System of the Heart - now with audio! Pulmonary Embolism • 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. 4 The self-contented right ventricle. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. acute hemodynamically compromised. Review possible indications, contraindications, adverse effects and outcomes of using thrombolytic therapy in . New strategies with new AC drugs Heparin Fondaparinux AVK Dabigatran, Edoxaban Heparin Fondaparinux ... Présentation PowerPoint Author: Jacqueline 36/Number 5, May 2004. 6 Treatment in the acute phase. 8 Chronic treatment and prevention of recurrence. Pulmonary embolism (PE) covers a wide spectrum of clinical severities, ranging from low-risk to life-threatening. presnted by marianne adly under the supervision of prof. seham hafez. This free Pulmonary Embolism medical ppt is one of the free medical PowerPoint templates available for medical and healthcare professionals on MedicPresents.com. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. brenna_cassidy1. Symptoms and signs of pulmonary embolism are non-specific, and the clinical presentation can vary greatly, depending on the time course and the extent to which and how fast the pulmonary vascular bed gets obstructed .Concerning the diagnostic and therapeutic management, the differentiation between hemodynamically stable and unstable patients is of utmost … Pulmonary embolism • Definition & Sources • Risk factors & aetiology • Pathogenesis • Clinical presentation • Differential Diagnosis • Investigations • Management • Complications • Prevention 20/01/20162 3. 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. JAMA 2014;311:2414-21. objectives. From Risk Stratification Standpoint: Low Risk PE: … 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. No public clipboards found for this slide. oral, Program Information - . 10 Long-term sequelae of pulmonary embolism. Treatment • Anticoagulation: • Prevent recurrent thromboembolism (rate new PE is 23% in 24 hours versus 6% in treated patients—therapeutic aPTT) • Started if suspected (pretest probability > 50%) confirmed PE • Can always stop Heparin Drip • Unfractionated Heparin: • Dose 80 U/kg Bolus, 18 U/kg infusion. pulmonary embolism pulmonary circulation pulmonary vascular resistance hypoxic. Pulmonary Embolism PowerPoint Template with a White Background and Pulmonary Embolism Banner. Created by. Amina Adel Al-Qaysi Computed Tomography in the Diagnosis of Pulmonary Embolism - . Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, … The Question for Rural Hospitals.. Background Pulmonary embolism (PE) is a common and potentially fatal disease that is still underdiagnosed. Introduction – Pathophysiology Rules. September 24, 2019. Seminars and conferences require medical PPT presentations. clinical spectrum varies from small, incidental pe to massive pe associated with sudden death due, PULMONARY EMBOLISM - . APPENDIX B: Classifications of Pulmonary Embolism (PE) APPENDIX A: Criteria for After Hours STAT 2D-ECHO Criteria Patient has to be seen first by a member of the PERT team in order to confirm that none of the other imaging modalities are possible (CT angiogram or VQ scan) Patient is hemodynamically unstable (Systolic Blood Pressure (SBP) less than 90 mmHg or receiving vasopressors) Many centers now regard fibrinolysis as the primary treatment of choice for all patients with PE and even for all patients who have DVT without evidence of PE” (emedicine) • “Fibrinolysis is always indicated for hemodynamically unstable patients with PE, because no other medical therapy can improve acute cor pulmonale quickly enough to save the patient's life” (emedicine), Fibrinolytics • Reteplase: second generation • FDA has not approved reteplase for use in PE • Works faster • More effective against larger clot burden • Allows more clot dissolution • 10 unit IVP Q30min X2 • Arrest: single 20 unit IVP • Alteplase: Drug most commonly used in the ED • Approved by FDA for use in PE • 100 mg IV infusion over 2 h • Accelerated 90-min regimen, most authors believe it is both safer and more effective than 2-h infusion (emedicine) • Weight based • Turn off heparin during infusion • Aspirin Contraindicated, Bleeding Complications • Reversal with FFP • Usually 2 units • Reversal with epsilon-aminocaproic acid • Amicar: 4-5 gms PO/IV over 1 hour then 1 gm/hour as needed, Consultations • Decision to treat with thrombolytics • Solely the responsibility of the ER doctor • Interventional Radiology • Catheter directed thrombolytics in selected patients • Placement of IVC filter • Possible treatment of DVTs • Rrosen’s: catherter-associated venous thrombosis and for non-catheter related • Decrease recurrence rate of DVT by 50% • Decrease crippling postphelbitic syndrome by 70%, Pitfalls: emedicine • Dismissing complaints of unexplained shortness of breath as anxiety or hyperventilation without an adequate workup • Dismissing complaints of unexplained chest pain as musculoskeletal pain without an adequate workup • Failure to properly diagnose and treat symptomatic DVT • Failure to recognize that DVT below the knee is just as serious as more proximal DVT • Failure to order a V/Q scan when a patient has symptoms consistent with PE • Failure to pursue the diagnosis after a V/Q scan that is not perfectly normal • Failure to start full-dose heparin at the first real suspicion of PE, before the V/Q scan • Failure to give fibrinolytic therapy immediately when a patient with PE becomes hemodynamically unstable. patients with known or suspected PE. See our Privacy Policy and User Agreement for details. Among patients with systemic lupus erythematosus, it is well known that they are prone to venous thromboembolism. Although a blood clot is the most common trigger, other culprits could be a fat or air embolism. A presentation from the How should I treat acute pulmonary embolism? University The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. Chatterjee S, Chakraborty A, Weinberg I, et al. A&A Practice: August 15th, 2015 - Volume 5 - Issue 4 - p 54–56. Review the pathophysiology of Pulmonary Embolus (PE) on the cardiopulmonary system. doi: 10.1213/XAA.0000000000000174. They should be essential in everyday clinical decision making. ACEP Recommendations • "In patients with a low-to-moderate pretest probability of PE, and a non-diagnostic V/Q scan, use one of the following tests instead of pulmonary arteriogram to exclude clinically significant PE: • A negative quantitative D-dimer assay (turbidimetric or ELISA). 2 Pulmonary Embolism- Statistics • 300k-600k per year • 1-2 per 1000 people, or as high as 1 in 100 if > 80 years old • 3rd leading cause of cardiovascular death behind myocardial infarction and stroke • Most commonly from lower extremity DVT • Evidence of DVT in > 50% cdc.gov; Agency for Healthcare Research and Quality Computerized tomographic angiography has become the mainstay of diagnosis. 5 The spiral of death! This case presentation shows two life threatening diseases can occur together, and Occam’s razor is not always the case in the Emergency Department. • 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. Data: CXR: infiltrate in RLL EKG: NSR at 95 with RBBB and inferior flipped Ts in II and III, ABG A-a gradient is 10, WBC of 12, Cr 2.1, PT/PTT of 12/80. 20/01/20161. Patients with a prior history of PE and those with known deficiencies of protein C, protein S, or antithrombin III should be included in this latter group. 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). • Level B recommendation that a negative whole blood D-dimer assay in a low pre-test probability patient as assessed by the Wells criteria excludes PE or lower extremity DVT • There was insufficient evidence to make any Level B recommendations in regard to utilizing the whole blood qualitative D-dimer assay without Well's clinical scoring system. › Get more: Pulmonary embolism powerpoint presentation Show List Health . Most patients with pulmonary embolism have no obvious symptoms at presentation. Dedicated DOAC Trials for the Treatment of Pulmonary Embolism. 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. 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. 10 Mythology of PE Myth. It is crucial to not anchor on one diagnosis, and to continue to investigate in patients with SLE presenting with shortness of breath. Inall four cases, acute pulmonary embolism was shown to be the etiologyofthe defecatioo-associatedevents. Jiménez D, Aujesky D, Moores L, et al. Acute Heart Failure. • Conversely, 62% of patients on anticoagulation therapy for suspected PE and subsequently died, no PE was found on autopsy, DVT to PE • Diagnosis of DVT • 600,000 hospitalizations • Diagnosis is underestimated • Diagnosis of PE • 400,000 missed each year • Mortality if untreated is 20-30% • Mortality if treated is 2-10% • 100,000 potential lawsuits • Cardiac arrest (PEA): TEE demonstrated 36% prevalence rate for PE, Vichow’s Triad • Hypercoagulability • Endothelial damage • Stasis, Thromboembolism Risk Factors • Age > 40 (old age in Rosen’s) • History of venous thromboembolism • Surgery longer than 30 minutes • Prolonged immobilization (airplanes—ASA) • CHF • Cancer • Obesity • Pregnancy or recent delivery • Hormone replacement therapy • Hypercoagulable states, Thromboembolism Risk Factors • Hypercoagulable states • Factor V Leiden (Most common) • AT III deficiency • Protein C deficiency • Protein S deficiency • Prothrombin G20210A mutation • Anticardiolipin antibody syndrome • Lupus anticoagulant, DVT • Homans’ and pseudo-Homans’ • Pseudo-Homans’: tenderness when squeezing the calf • Homans’: Foot held in plantar flexation • Repudiated by Homan himself • Classic physical findings present • Only 50% have DVT • Plegmasia Dolens • White, painful, edematous, cold, and pulseless • Limb threat—call vascular—or amputation required • Approx. more common than one would thinkalmost ? ACEP Recommendations • PE policy Level B recommendation states, "Consider fibrinolytic therapy in hemodynamically unstable patients with confirmed PE." Deep-vein thrombosis (DVT) is a type of clot that forms in a major vein of the leg or, less commonly, in the arms, pelvis, or other large veins in the body. STUDY. mary pak, md primary care conference august 25, 2004. objectives. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. no associated/alleving factors. A work up of PE is started. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to … 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 PULMONARY EMBOLISM MANAGEMENT AND THROMBOLYSIS John Simpson Professor of Respiratory Medicine Newcastle University. The presentation of pulmonary embolism may vary from sudden catastrophic hemodynamic collapse to gradually progressive dyspnea. Pulmonary Infarction Submassive Embolism Massive Embolism. Overview of pulmonary circulation 2. Acute Pulmonary Embolism. 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. If you continue browsing the site, you agree to the use of cookies on this website. Pulmonary embolism (PE) is a relatively common vascular disease with potentially life-threatening complications in the short term. scott m silvers, md 1 st pan american conference emergency, Preoperative Pulmonary Evaluation - . Jaff MR, McMurtry MS, Archer SL, et al. PULMONARY EMBOLISM PRESENTED BY, RESMI G S 2. Export All Images to PowerPoint File; Share this article on: Atypical Presentation of a Pulmonary Embolism in the Perioperative Setting ... Atypical Presentation of a Pulmonary Embolism in the Perioperative Setting. Pulmonary embolism. Clipping is a handy way to collect important slides you want to go back to later. cheryl pollock pgy-3. understand radiologic studies used to, Pulmonary Vascular Diseases - Pulmonary embolism. clinical case. The Level C recommendation states, "Consider fibrinolytic therapy in hemodynamically stable patients with confirmed PE and RV dysfunction on echocardiography," and, in unstable patients with high clinical index of suspicion, especially if RV dysfunction can be demonstrated on bedside echocardiography. Looks like you’ve clipped this slide to already. However, the final decisions concerning an individual patient must … incidence. Taking measures to prevent blood clots in your legs will help protect you against pulmonary embolism. HR 105, RR 24, BP 140/80. Features of these Circulatory Pulmonary Embolism PowerPoint presentation templates: Instant download Attractive subscription prices Premium quality presentation templates on affordable price Mac and Keynote compatible … The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to … Viswanath, Omar MD; Simpao, Allan F. MD; Santhosh, Sushmitha MD. Pulmonary Embolism – Overview on Management. 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. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. 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. Peripheral arterial disease can be subdivided into occlusive disease, … 2 New European Society of Cardiology guidelines. Jeff Curly Hurley MD Martin Luther King Jr. Hospital Charles Drew University. sudden, profound, and . Users can find out many more related PowerPoint templates online and make an elegant Pulmonary Embolism PowerPoint Template. Use this template for presentations on Pulmonary Embolism etc. However, prompt treatment greatly reduces the risk of death. Match. 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) . In more severe cases, secondary right ventricular failure may result from myocardial ischaemia and injury caused by systemic hypotension and adrenergic overstimulation. 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