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Pulmonary Embolism, Classification & Guidelines

Pulmonary Embolism, Classification & Guidelines
by

Denis Alfonso

on 19 December 2014

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Transcript of Pulmonary Embolism, Classification & Guidelines

Pulmonary Embolism Guidelines
Contraindications to Fibrinolysis:

Absolute contraindications

- Intracranial hemorrhage
- Ischemic stroke within 3 months
- Suspected aortic dissection
- Active bleeding
- Recent head or facial trauma
- Evidence of brain injury

Pulmonary Embolism Guidelines
Anticoagulation:

- Anticoagulate with LMWH, IV

Fibrinolytics:

- Reasonable for pts with massive PE and acceptable risk of bleeding complications

Fibrinolytic Drugs:

- Streptokinase, Alteplase, Reteplase, and Tenecteplase

Classification & Guidelines
Pulmonary Embolism Guidelines
Contraindications to Fibrinolysis:

Relative contraindications

- Age >75 years
- Pregnancy
- Prolonged CPR (>10 minutes)
- Recent internal bleeding
- Uncontrolled hypertension
- Dementia
- Surgery within 3 weeks

Classification of Pulmonary Embolism
Pulmonary Embolism (PE) is a blockage of the main artery of the lungs or one of its branches

PE most commonly results from Deep Vein Thrombosis (DVT) that breaks off and migrates to the lung

A process termed Venous Thromboembolism (VTE)

Pulmonary Embolism Guidelines
Interventional and Surgical Options:


- Catheter Embolectomy and surgical Embolectomy can be considered

- Depends on institutional and operator preference

- Reasonable if the pt is still unstable in massive PE

Pulmonary Embolism


Classification of Pulmonary Embolism
Massive PE:

- The principal criteria for categorizing PE as massive are arterial hypotension and cardiogenic shock

- Defined with a systolic arterial pressure <90 mm Hg or a drop in systolic arterial pressure of at least 40 mm Hg for at least 15 minutes

- Shock is manifested by tissue hypoperfusion and hypoxia, including an altered level of consciousness, oliguria, or cool, clammy extremities
Classification of Pulmonary Embolism
Submassive PE:
- Patients with submassive PE can be identified by the presence of RV dysfunction detected on physical examination with EKG

- Physical examination findings of tachycardia, elevated jugular venous pressure, right parasternal heave, accentuated sound of pulmonic valve closure, and hepatomegaly suggest RV dysfunction

- Elevations in cardiac biomarkers, including troponin, brain-type natriuretic peptide, and heart-type fatty acid–binding protein
By: Denis Alfonso

Cardiovascular and Thoracic Surgery
Full transcript