Dr. Adnan M. Al- Jubouri
Lec. 5
PULMONARY
THROMBO-EMBOLISM
Tues. 29 / 12 / 2015
Done By: Ibraheem Kais
2015 – 2016
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ﺷﻮﺭ ﻟﻼﺳﺘﻨﺴﺎﺥ
Pulmonary thrombo-embolism Dr. Adnan M. Al- Jubouri
29-12-2015
1
Pulmonary Thrombo-Embolism
It is a blockage of the pulmonary artery or its tributaries by an embolus coming
from DVT in 90% of cases, while the other 10% comes from the heart.
The burden of PTE
PM findings:
5% of hospital deaths are due to PTE.
While 40-50% who die in hospital were found to have DVT.
This indicates that PTE is a common problem in hospital practice.
Thromboembolism epidemiology
Thromboembolism is a disease of hospitalized patients
Pulmonary thrombo-embolism Dr. Adnan M. Al- Jubouri
29-12-2015
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DVT
Clinical features
Unilateral leg swelling & pain in the thigh & calf muscles.
O/ E: the leg is swollen, tender, hot, and pitting oedema is present.
Virchow’s triad
Venous thromboembolism
Pulmonary thrombo-embolism Dr. Adnan M. Al- Jubouri
29-12-2015
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Clinical presentation
Clinical features of DVT.
Clinical features of the type of PTE:
1. Massive PTE.
2. Less massive PTE.
3. Pulmonary infarction.
4. Recurrent small pulmonary emboli.
Diagnosis
Clinical (DVT, Type, Suspect).
Radiological (CXR, PCTA, Cath).
ECG.
ECHO.
Radioactive scan (V/Q).
Lab. Investigation (D-dimer).
Clinical prediction rules
Factor
points
• Signs and symptoms of DVT
3
• Alternate diagnosis less likely
3
• Pulse >100
1.5
• Immobilization / surgery w/i 4 wk
1.5
• Previous DVT/PE
1.5
• Hemoptysis
1
• Malignancy
1
High > 6 (50%), Moderate 2-6 (19%), Low <2 (2%)
Pulmonary thrombo-embolism Dr. Adnan M. Al- Jubouri
29-12-2015
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Management
A. Prevention:
o Early postoperative mobilization.
o Correct faulty posture.
o Exercise during long journey.
o Treatment of dehydration & CHF.
o IVC emboli prevention.
o Prophylaxis.
B. Treatment of established PTE.
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