Management Of Pulmonary Embolus Research Articles

Contemporary Treatment of Pulmonary Embolism: Medical Treatment and Management.

Pulmonary embolus (PE) is defined as obstruction of the pulmonary artery or one of its branches by material (e.g., thrombus, tumor, air, or fat) but most commonly due to thrombus originating from the lower extremity deep veins. We reviewed the current literature describing the optimal medical treatment and management of PE. Databases (PubMed, the Cochrane Library, Embase, EBSCO, Web of Science, and CINAHL) were searched for relevant studies and guidelines for management of patients with PE. The initial approach to patients with suspected PE should focus upon stabilizing the patient while further workup for risk stratification is in progress. In most cases, anticoagulation should ideally be started even prior to confirming PE, if risk-benefit regarding suspicion of PE and bleeding risk is favorable. Once the diagnosis is confirmed, risk stratification will guide further therapies consisting of anticoagulation, thrombolysis, or catheter-directed interventions. Data for initial, long-term, and indefinite anticoagulation, and factors that determine whether or not a patient can be treated in the outpatient setting, are reviewed and discussed.

Outpatient treatment of pulmonary embolism: A single center 4-year experience.

Pulmonary embolus (PE) is associated with significant utilization of health resources. As patients can be risk-stratified, there is an opportunity for a subset of patients to be safely treated without hospitalization, thus reducing the associated costs of treatment. Our aim was to describe the population, treatment strategies, complications, and outcomes associated with outpatient management of PE following treatment in the ED. This retrospective health records survey investigated a 4-year cohort of patients presenting with PE who were discharged to home. Data from 151 patients demonstrated that 78% (118/151) of patients were discharged directly home; 19% (28/151) were discharged following ED clinical decision unit observation. Treatment with a novel oral anticoagulant was provided in 40% of cases (61/151). Six patients (4%) experienced a medication-related complication; 26 (17%) had a return visit within 30days. In this cohort of patients with PE, outpatient management was safe and effective for the large majority. Immediate and 30-day complications were few.

Management of Pulmonary Emboli During a Spinal Cord Stimulator Trial: A Case Report

Background: Neuromodulation has been used in the management of chronic pain for well over 30 years and is becoming increasingly relevant in the face of the ongoing opioid epidemic. Although this therapy continues to provide pain relief and improvement in function to patients with a wide variety of pathologies, several complications have been described ranging from lead migration to development of a granuloma causing cord compression. Although not described in the literature, a pulmonary embolism can be one of the rare complications of a spinal cord stimulation procedure, and when it happens during the trial period of spinal cord stimulation, it involves significant challenges in the clinical management of anticoagulation in the patient. Case Report: We present a case in which a patient developed bilateral pulmonary emboli (PE) during the trial phase of spinal cord stimulation. The patient did have a prior history of PE, had an inferior vena cava filter in place, and was on anticoagulation, which was held as per the current American Society of Regional Anesthesia guidelines prior to the spinal cord stimulator (SCS) trial. Conclusion: A pulmonary embolus is a possible complication from an SCS trial, especially in patients with preexisting thromboembolic risk factors. Management must involve multidisciplinary care focused on balancing the risks of thrombosis with those from a potential epidural hematoma at the time of lead removal. Key words: Spinal cord stimulation, pulmonary embolus, spinal cord stimulator complications, neuromodulation, venous thromboembolism, SCS trial, VTE, PE

Outpatient management of pulmonary emboli: when to ambulate.

Pulmonary embolism is a potentially fatal consequence of venous thromboembolism and constitutes a significant proportion of the acute medical take. Standard management has previously required admission of all patients presenting with acute pulmonary embolism for initiation of anticoagulation and initial investigations. However, clinical trial data have demonstrated the feasibility and safety of managing a subset of patients with low-risk pulmonary embolism in the outpatient setting and this has since been reflected in national guidelines. This article provides a practical overview for general physicians with regards to identifying patients with low-risk pulmonary embolism, and when and how to manage these patients on an outpatient basis.

PMM.18 Thrombolysis for massive pulmonary embolism in pregnancy: A case report and literature review

Venous thromboembolism (VTE) remains to be the leading cause of maternal mortality. The management of pulmonary embolus (PE) in pregnancy is complicated by the lack of validated trials. The use...

Management of Peripheral Pulmonary Emboli with the Use of Transvenous Catheter-Directed Thrombolysis and Right Ventricular Assist Device

Pulmonary emboli (PE) can result in significant hemodynamic instability that requires urgent intervention; however, the management of peripheral emboli has been controversial. We present two patients in whom a right ventricular assist device (RVAD) was used in treating peripheral pulmonary embolism, applying the technique of pulmonary artery catheter-directed thrombolysis after resuscitation with an RVAD. The clot burden was not suitable for surgical embolectomy due to its peripheral locations. The patients' hemodynamic conditions improved with thrombolytic therapy and gradually were weaned off the RVAD. Follow-up scans showed near resolution of all PE. Catheter-directed thrombolysis with an RVAD as an adjunct should be considered in management of peripheral PE.

Surgical Management of Pulmonary Embolus

There is mounting evidence to guide the clinician in the management of both the acute presentation of pulmonary embolus and its chronic state. In this article we will review the role of surgery in both. Its role in acute presentation is not so clear despite 85 years passing since the first reported case of surgical pulmonary embolectomy. Pulmonary embolus is a particularly life-threatening complication when combined with shock, hypotension or right ventricular dysfunction. Essentially, surgical embolectomy has been reserved for high-risk patients. The current survival rate is around 70%. The treatment of choice for most patients with symptomatic chronic thromboembolic pulmonary hypertension is surgical disobliteration by pulmonary endarterectomy, a comparatively novel surgical procedure. This is the only treatment proved to offer significant symptomatic and prognostic benefit and should be distinguished from pulmonary embolectomy for acute embolus. The in-hospital survival rate (95%) for pulmonary endarterectomy in specialist centres is excellent, and patients enjoy a significant reduction in symptoms and increased life expectancy.

The imaging implications of implementing the BTS guidelines for management of acute PE

The BTS has recently published new guidelines for the investigation of suspected pulmonary embolus (PE). The management pathway requires a reliable assessment with all patients of low or intermediate clinical probability having a D-dimer assay. If the D-dimer is negative, no further investigation for PE is recommended. For patients with a high clinical probability or a positive D-dimer assay, imaging is recommended with a preference for CTPA, particularly if the CXR is abnormal. We performed a retrospective review of the 859 V/Q studies over a 12 month period from August 2002 to July 2003 to evaluate the clinical outcome of the patient's study and to determine whether other imaging was performed. Seventeen per cent of these studies had an abnormal CXR. Overall, 41.8% of the studies were normal, with the following probabilities for acute PE: low 37.6%, intermediate 5.6%, and high 15%. Further imaging was performed in 96 patients (11.1%), 22 patients with an intermediate V/Q scan had a CTPA with 9 being positive and 15 negative. Given that the radiation and financial burden of V/Q and CTPA are 1.2 mSv and £380 vs 4.2 mSv and £120, respectively, we conclude that it is justifiable to use the V/Q as the gatekeeper in PE imaging reserving CTPA for intermediate V/Q results.

Management of pulmonary embolus in pregnancy.

Management of pulmonary embolus in pregnancy.

Diagnosing pulmonary embolism

AbstractDiagnosing pulmonary embolus (PE) remains one of the great challenges of emergency medicine. The diagnosis relies on a balance of probabilities rather than any definitive test. The probability is based on history, examination and investigations. The principal investigations are chest X‐ray, arterial blood gas, electrocardiograph, ventilation perfusion scan, ultrasound and angiography where necessary. Newer techniques such as CT scan and magnetic resonance imaging will become more useful as the technology improves. Transoesophoegeal echocardiography is an important investigative tool for massive PE.Thrombolysis is increasingly being used in the management of PE and the higher risk of adverse outcome should be balanced against the probability of false positive results and the use of invasive angiography.