RT Book, Section
A1 Meyer, Nuala J.
A1 Schmidt, Gregory A.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2285540
T1 Chapter 27. Pulmonary Embolic Disorders: Thrombus, Air, and Fat
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accessmedicine.mhmedical.com/content.aspx?aid=2285540
RD 2021/04/15
AB Pulmonary  embolism  (PE)  is  common,  underdiagnosed,  and  lethal,  yet  readily  treatable.Prophylaxis  and  accurate  diagnosis  are  essential  to  improving  outcome.The  cause  of  death  in  PE  is  most  often  circulatory  failure  (acute  cor  pulmonale)  due  to  right  heart  ischemia.There  is  no  perfect  diagnostic  test  for  PE;  accurate  diagnosis  requires  both  an  informed  clinical  pretest  probability  and  a  stepwise  application  of  tests  including  D-dimer,  helical  CT  angiography,  and  lower  extremity  duplex.A  careful  risk  assessment  may  identify  patients  ideal  for  outpatient  therapy.  Conversely,  patients  with  hypotension,  cancer,  heart  failure,  hypoxemia,  and  present  or  prior  deep  vein  thrombosis  are  at  significantly  higher  risk  for  death,  recurrence,  or  major  bleeding  from  PE,  and  are  best  managed  in  an  appropriately  monitored  setting.Low  molecular  weight  heparin  (LMWH)  is  approved  and  recommended  as  the  initial  therapy  for  PE,  and  should  be  used  in  most  patients  unless  there  exists  a  compelling  reason  to  do  otherwise.  When  LMWH  is  not  used,  unfractionated  heparin  is  typically  used  to  maintain  the  partial  thromboplastin  time  at  1.5  to  2.5  times  control.  Numerous  new  anticoagulants  are  being  tested  and  may  soon  be  approved  for  the  treatment  of  PE.Critically  ill  patients  may  especially  benefit  from  aggressive  use  of  vena  caval  interruption.Thrombolytic  therapy  is  life-saving  in  patients  with  massive  embolism  and  circulatory  instability.Air  and  fat  embolism  usually  present  as  acute  respiratory  distress  syndrome,  and  are  managed  with  mechanical  ventilation,  oxygen,  and  positive  end-expiratory  pressure.