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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Saturday, December 26, 2015

Embolismo pulmonar: paciente inestable

emDocs - December 26, 2015 - Author: Troha D - Edited by: Koyfman A and Long B
"In the emergency department, we are responsible for identifying and treating life-threatening conditions. When a patient presents with acute onset dyspnea, chest pain, syncope, or hemoptysis, the diagnosis of pulmonary embolism (PE) often comes to mind; however, PE may escape prompt diagnosis when the clinical signs and symptoms are not as specific. Systemic arterial hypotension is a rare but life-threatening presentation of acute PE. The PIOPED II database suggests that only 8% of patients present with overt circulatory collapse. Even in these patients, respiratory distress is present in 91%.
Massive (high risk) PE is defined as systolic BP less than 90 mm Hg or a systolic pressure drop greater than or equal to 40 mm Hg for greater than 15 minutes, not due to new-onset arrhythmia, hypovolemia, or sepsis. It should be noted that the word “massive” does not refer to clot burden, but refers to the presence of shock in the setting of acute PE. Massive PE carries a high mortality rate, likely somewhere around 30-50%. Because of this, aggressive measures must be taken to resuscitate and stabilize these patients."
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