3 What we will and won’t talk about Risk stratification and how it guides treatment Treatment X (CTEPH) IVC filters Cancer Pregnancy VTE in ICU. A 34 year old obese G4 P3 female at 36 weeks pregnancy and has a broken ankle complains of shortness of breath and pleurtic chest pain x 30 minutes. heart disease; VTE/PE, venous thromboembolism and pulmonary embolism. Most of the time, a pulmonary embolism is caused by a blood clot travelling up from one of the deep veins in your legs. Which of the following statments is correct: • Heparin exerts its effects on Factors II,VII, IX,X, protein C, protein S • Lovenox has greater factor IIa effect than heparin • An INR of greater than 3 is theraputic in patients with hypercoagulability states • Fibrinoltics should be given concominately with heparin • Aspirin should be given to patients with PE • Lepirudin is the first line treatment for Protein C and Protein S deficiency, © 2020 SlideServe | Powered By DigitalOfficePro, - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -. INTRODUCTION Problems of the vascular system includes disorders of the arteries and veins. presnted by marianne adly under the supervision of prof. seham hafez. celia m. divino, m.d. 7 Integrated risk-adapted diagnosis and management. Graphs and diagrams slides to give professional look to you presentation. The Question for Rural Hospitals.. 5 The spiral of death! Risk-adjusted management algorithm . Peripheral arterial disease is a term used to describe a wide variety of conditions affecting arteries in the neck, abdomen and extremities. mount sinai school of, Outpatient Treatment of Acute Pulmonary Embolism: Review of Published Studies - . The classic presentation of PE is the abrupt onset of pleuritic chest pain, shortness of breath, and Objectives. journal article. It is crucial to not anchor on one diagnosis, and to continue to investigate in patients with SLE presenting with shortness of breath. From Risk Stratification Standpoint: Low Risk PE: … coagulation cascade. session at ESC CONGRESS 2019 In order to bring you the best possible user experience, this site uses Javascript. RAK Medical & Health Sciences Having blood clots in deep veins (deep vein thrombosis) can lead to pulmonary embolism. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Perspective. It can happen for no obvious reason. Data Source: Special analyses, Medicare 5% sample. sudden, profound, and . Overview of pulmonary circulation 2. A presentation from the How should I treat acute pulmonary embolism? September 24, 2019. pulmonary embolism (pe) refers to. A&A Practice: August 15th, 2015 - Volume 5 - Issue 4 - p 54–56. Introduction – Pathophysiology Rules. Pulmonary embolism associated with the act ofdefecation has not beeD previously well described. Data: CXR: infiltrate in RLL EKG: NSR at 95 with RBBB and inferior flipped Ts in II and III, ABG A-a gradient is 10, WBC of 12, Cr 2.1, PT/PTT of 12/80. pulmonary embolism. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. • A negative single bilateral venous ultrasonographic scan for low-probability patients. Features of these Circulatory Pulmonary Embolism PowerPoint presentation templates: Instant download Attractive subscription prices Premium quality presentation templates on affordable price Mac and Keynote compatible … brenna_cassidy1. [1] Patients with low-risk PE are characterised by a normal blood pressure, normal biomarkers and no right ventricular dysfunction. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. APPENDIX B: Classifications of Pulmonary Embolism (PE) APPENDIX A: Criteria for After Hours STAT 2D-ECHO Criteria Patient has to be seen first by a member of the PERT team in order to confirm that none of the other imaging modalities are possible (CT angiogram or VQ scan) Patient is hemodynamically unstable (Systolic Blood Pressure (SBP) less than 90 mmHg or receiving vasopressors) 6 Treatment in the acute phase. This has never happened in her previous pregnancies. Review possible indications, contraindications, adverse effects and outcomes of using thrombolytic therapy in . Health Details: Pulmonary embolism occurs when a mass, generally a blood clot, obstructs blood flow to the lungs. Pulmonary Embolism. Derivation and validation of a prognostic model for pulmonary embolism. (Prior poor cardiopulmonary status of the patient is an important factor leading to hemodynamic collapse.) 1006 pts with confirmed PE + RV dysfunction detected by ECHO or CTPA + troponin. Pulmonary embolism (PE) is when a blood clot (thrombus) becomes lodged in an artery in the lung and blocks blood flow to the lung. ACEP Recommendations • PE policy Level B recommendation states, "Consider fibrinolytic therapy in hemodynamically unstable patients with confirmed PE." The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to … Write. This free Pulmonary Embolism medical ppt is one of the free medical PowerPoint templates available for medical and healthcare professionals on MedicPresents.com. unexpected maternal collapse . oral, Program Information - . editabletemplates.com's Circulatory Pulmonary Embolism presentation templates are available with charts & diagrams and easy to use. Oct 21, 2013 - Pulmonary Embolism PowerPoint Template comes with different editable charts. Free + Easy to edit + Professional + Lots backgrounds. Pulmonary Embolism PE Epidemiology Pathophysiology Prevention/Risk factors Screening Diagnosis Treatment PE Epidemiology Five million cases of venous thrombosis ... – A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 3cd1d1-MGM2N This Pulmonary Embolism ppt template design is used by many professionals. JAMA 2014;311:2414-21. chee m. chan, md pulmonary and critical care medicine, D-dimer in the Diagnosis of Pulmonary Embolism - . Patients with pulmonary embolism are short of breath and have chest pain! Peripheral arterial disease can be subdivided into occlusive disease, … Created by. ... culture and treat appropriately Pulmonary edema- caused by rapid infusion Pulmonary embolism - Caused by any free floating substances that require thrombolytic therapy for several months. Pulmonary Embolism. Pulmonary embolism (PE) occurs when a thrombus dislodges from a vein, flows through the veins and typically lodges in the lung. Pulmonary Embolism PowerPoint Template with a White Background and Pulmonary Embolism Banner. Review the pathophysiology of Pulmonary Embolus (PE) on the cardiopulmonary system. Moderate pulmonary embolism treated with thrombolysis (from the "MOPETT" Trial). Pulmonary embolism - . Create stunning presentation online in just 3 steps. chang shim, md professor of medicine jacobi medical center. 10 Mythology of PE Myth. Most patients with pulmonary embolism have no obvious symptoms at presentation. with diagnosed PE • INR: if therapeutic (INR 2-3), no imaging • NEW symptoms suggestive of recurrent PE: use the same imaging modality • Massive Obesity • Greater than 400 lbs • CT, V/Q, Angiogram: not feasible • Venous ultrasound • D-Dimer: greater than 2000—treat (no evidence backing this recommendation—Tintinalli’s), Special Populations • Pregnancy • Involve obstetrician and radiologist • Half dose injection V/Q scan • CT angiogram • Quantitative D-Dimer should not exceed 1000 ng/mL • Doppler ultrasound • Hypercoagulability • May require higher INRs to be therapeutic ( >3) • May render heparin and LMWH ineffective. Match. Find PowerPoint Presentations and Slides using the power of XPowerPoint.com, find free presentations research about Pulmonary Fat Embolism PPT . › Get more: Pulmonary embolism powerpoint presentation Show List Health . Three Clinical Presentations. Many of these cases are diagnosed in the emergency Jeff Curly Hurley MD Martin Luther King Jr. Hospital Charles Drew University. postoperative, TABLE 1 Modified Wells Criteria Clinical Assessment for pulmonary embolism - Diagnostic treatment algorithm for suspected, Oral Anticoagulants In Pulmonary Embolism - . www.anaesthesia.co.in anaesthesia.co.in@gmail.com. Use this template for presentations on Pulmonary Embolism etc. The Geneva Score which is also reflected in the ESC Guideline on pulmonary embolism predicted a low probability of a pulmonary artery embolism with 3 points for a heart rate between 74 and 94 /min, an active cancer was not known at that time, and all other points were negative. Pulmonary Embolism PowerPoint Template Presentation theme includes 1 title background … air enters the vasculature ↓ pulmonary, Anticoagulant Therapy - . Pulmonary Embolism PowerPoint Template with a White Background and Pulmonary Embolism Banner. No risk factors could be identified in 28 percent of the younger group. Pulmonary Embolism PowerPoint Template with a White Background and Pulmonary Embolism Banner. References • Marx, John MD, et al., Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed, Mosby, 2002. Pulmonary Infarction Submassive Embolism Massive Embolism. 20/01/20161. Often, we don’t know the cause of a pulmonary embolism. Description: Download MedicPresents.com's free Circulatory Pulmonary Embolism Medical PowerPoint Template now for your upcoming medical PowerPoint presentations. She was found to have simultaneous pulmonary embolism and flash pulmonary edema. Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs. Which of the following is true for this patient: • Fibrinolytics should be given if PE is confirmed • Heparin should be started immediately since PE is strongly suspected • Enoxaparin is a better choice for anticoagulation since it has better Xa:IIa ratio • Fibrinolytics should be considered only if RV strain/dysfunction demonstrated • TNKase is the drug of choice, Answer • Fibrinolytic therapy is mandatory for 3 groups of patients: those who are hemodynamically unstable, those with right heart strain and exhausted cardiopulmonary reserves, and those who are expected to have multiple recurrences of pulmonary thromboembolism over a period of years. • Alteplace and aspirin should be given if PE on CT since there is evidence of right heart strain • The A-a gradient rules out PE • Patient does not need anticoagulation • D-Dimer should be ordered regardless of pretest probability • Pneumonia is not in the differential • Patient has an autoimmune disease, Questions 4. Perspective. If you continue browsing the site, you agree to the use of cookies on this website. 2 Pulmonary Embolism- Statistics • 300k-600k per year • 1-2 per 1000 people, or as high as 1 in 100 if > 80 years old • 3rd leading cause of cardiovascular death behind myocardial infarction and stroke • Most commonly from lower extremity DVT • Evidence of DVT in > 50% cdc.gov; Agency for Healthcare Research and Quality Special thanks to Dr. Scott Solomon, Professor of Medicine at Harvard Medical School for your awesome Illustrative Case Presentation at the 2012 ASE Scientific Sessions – your presentation really helped explain and demonstrate pulmonary embolism in echocardiography! Arteries Hampton’s hump (35%) Westermark’s sign (7%) ECG to R/O: ACS/Pericarditis/Strain--prognostic ECG S1Q3T3 (indication of right heart strain—20-50%) ST-segment changes (8-69%) Non-specific ST-T wave changes (49-77%) RBBB (6-67%) T-Wave inversions (23-64%) Atrial arrhythmias (3-66%) Normal (9-30%) Initial Studies, ABG • ABG has zero predictive value • A-a Gradient is often increased secondary to other pulmonary pathology • Gradient is usually about 15 in most patients • PE does not often produce abnormalities in gas exchange • Most patients have a PaO2 less than 80 (75%) • PaO2 is very sensitive to minute ventilation • 1-2 breaths/ minute may normalize the PaO2 • Pulse ox often normal (100% tends to exclude PE) • PIOPED Data: • Low Sensitivity • 14-38% of patients with normal ABG had PE, Clinical Probability: Wells • Wells Criteria, D-Dimer • 34- D-Dimer assays with varying degrees of sensitivity • ELISA assays: highly sensitive (95-99%), expensive • Original tests were slow to be of value • Run in batches/Highly skilled lab/Impractical in the ER • Now rapid ELISAs are available with similar sensitivities • Latex agglutination: 85%-98% • Quantitative is gold standard D-Dimer Test: Considered positive if greater tan 500 ng/ml • A positive D-Dimer does not meet the requirements for an intent to treat • Lower sensitivity (latex and whole blood) D-Dimer insufficient to r/o PE ALONE • ACEP Recommendations: in conjunction with Well’s, D-Dimer • NEJM: D- Dimer only used in patients who are low risk for PE • High D-Dimer is meaningless • Not established a diagnosis • Side Note: D-Dimer not necessary/not helpful for DIC diagnosis • Platelet trend, FSP/FDP, Fibrinogen level, PT/PTT, D-Dimer • Half-life is 8 hours • Patients with symptoms of PE greater than 8 days • Patients may have normally elevated D-Dimers • Pregnant patients (75%) • Cancer patients (50%) • Postpartum 1 week • Age greater than 80 • Other disease processes: • Sepsis, hemorrhage, MI, stroke, collagen vascular diseases, liver disease, Sensitivity: ill A/(A +B) Specificity: well D/(C + D) Positive Predictive Value A/(A +C) Negative Predictive Value D/(B + D) Statistics, V/Q scan • PIOPED data show that the specificity is poor • Normal V/Q scans—did angiogram—9% positive for PE • High-probability scan sensitivity of 41% and specificity of 97% • 65% of V/Q scans are interpreted as low and intermediate scans which generally requires further investigation, Spiral CT Scan • Highly sensitivity: 98-99% • Safe • British Thoracic Society: recommendation that CTPA is the initial lung imaging study for suspected PE • NEJM: • Positive Helical CT: anticoagulation • Negative Helical CT: possible F/U with compression ultrasound then possible anticoagulation, Special Populations • Recurrent visits in Pts. Computerized tomographic angiography has become the mainstay of diagnosis. Taking measures to prevent blood clots in your legs will help protect you against pulmonary embolism. Be effective with all your medical PowerPoint presentations by easily filling your medical and healthcare content in our free Pulmonary Embolism medical background for PowerPoint. ACEP Recommendations • Level B recommendation that a quantitative D-dimer excludes PE or lower extremity DVT in low pre-test probability patients (as assessed either subjectively or by clinical scores). In most cases, pulmonary embolism is caused by a blood clot in the leg that breaks loose and travels to the lungs. Pulmonary embolism ppt 1. Pulmonary Embolism. The composite of death and pulmonary embolism at 90 days was approximately the same in severe trauma patients both with and without implanted inferior vena cava filters, a study found. A work up of PE is started. lack of public awareness(not like stroke and ACS) PE is a major cause of death in Treatment • Anticoagulation: • Prevent recurrent thromboembolism (rate new PE is 23% in 24 hours versus 6% in treated patients—therapeutic aPTT) • Started if suspected (pretest probability > 50%) confirmed PE • Can always stop Heparin Drip • Unfractionated Heparin: • Dose 80 U/kg Bolus, 18 U/kg infusion. 6 Things in the new gui 27 y.o. A 45 year old female Complains of Chest pain. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Displaying amniotic fluid embolism PowerPoint Presentations Amniotic Fluid Embolism Pain Free Partha PPT Presentation Summary : Amniotic fluid embolism (AFE) is a catastrophic obstetric emergency . more common than one would thinkalmost ? Viswanath, Omar MD; Simpao, Allan F. MD; Santhosh, Sushmitha MD. New strategies with new AC drugs Heparin Fondaparinux AVK Dabigatran, Edoxaban Heparin Fondaparinux ... Présentation PowerPoint Author: Jacqueline • Tintinalli, Judith MD, et al., Emergency Medicine:A Comprehensive Study Guide, 6th ed, McGraw-Hill, 2002. Which of the following is true: • Treat for PE only if the D-Dimer is greater than 500 ng/mL • Pregnancy is an absolute contraindiaction to fibrinolytics • Heparin should be started after obtaining imaging studies that confirm VTE or PTE • A negative Quantitative ELISA D-Dimer rules out PE • A V/Q scan is the study of choice • Helical CTPA is not contraindicated • Negative serial bilateral venous ultrasonographic scan rules out PE, Questions 3. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. No public clipboards found for this slide. Pulmonary embolism. Learn. Am J Cardiol 2013;111:273-7. Pulmonary Embolism /pulmonary Hypertension PPT Presentation Summary : VTE is the third most common cardiovascular condition after ACS and stroke. ACEP Recommendations • "In patients with a low-to-moderate pretest probability of PE, and a non-diagnostic V/Q scan, use one of the following tests instead of pulmonary arteriogram to exclude clinically significant PE: • A negative quantitative D-dimer assay (turbidimetric or ELISA). Most patients with pulmonary embolism have no obvious symptoms at presentation. Pulmonary Embolism PowerPoint Template Presentation theme includes 1 title background and 20 content slides with Charts and diagrams. Original and simplified pulmonary embolism severity index (PESI) patient related PE related . Pulmonary Embolism: Symptoms and Treatment - Step To Health. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. Acute Pulmonary Embolism. Aujesky D, Obrosky DS, Stone RA, et al. Embolism: Judoctors PPT. incidence. (Prior poor cardiopulmonary status of the patient is an important factor leading to hemodynamic collapse.) Presentation “I think I’m having a PE” Diagnosis Anxiety Treatment Now and Later Questions Designed to wreak havoc. PULMONARY EMBOLISM MANAGEMENT AND THROMBOLYSIS John Simpson Professor of Respiratory Medicine Newcastle University. Patients with a prior history of PE and those with known deficiencies of protein C, protein S, or antithrombin III should be included in this latter group. Users can find out many more related PowerPoint templates online and make an elegant Pulmonary Embolism PowerPoint Template. Pulmonary Embolism Jeff Curly Hurley MD Martin Luther King Jr. Hospital Charles Drew University, Objectives • Perspective • Are pulmonary embolisms bad? Seminars and conferences require medical PPT presentations. Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. – A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 3c6e08-NWJlZ Peter DeLong MD Pulmonary and Critical Care Medicine DHMC December 15, 2008 What we will cover Definition Epidemiology Risk factors Diagnosis Presentation tests algorithm Treatment Risk stratification Duration of therapy Monday mornings can be hard for everyone. Circulatory Pulmonary Embolism ppt template can also be used for topics like biology,tissue,embolus,deep,thrombus,shortness,healthcare,artery, etc. Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. However, prompt treatment greatly reduces the risk of death. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. You can find out millions of decent web medical templates available online, which are capable enough to cater the need of medical professionals and doctors. University no associated/alleving factors. 9 Pulmonary embolism and pregnancy. PE ppt gnp. Background Pulmonary embolism (PE) is a common and potentially fatal disease that is still underdiagnosed. Pulmonary embolism • Definition & Sources • Risk factors & aetiology • Pathogenesis • Clinical presentation • Differential Diagnosis • Investigations • Management • Complications • Prevention 20/01/20162 3. amjad almahameed, md, mph. Cardio-pulmonary obstruction to flow occurs in pulmonary embolism while intracranial obstruction (high ICP) occurs in subarachnoid hemorrhage. The objective of our study was to reappraise the clinical presentation of PE with emphasis on the identification of the symptoms and signs that prompt the patients to seek medical attention. Chatterjee S, Chakraborty A, Weinberg I, et al. STUDY. • Presentation • “I think I’m having a PE” • Diagnosis • Anxiety • Treatment • Now and Later • Questions • Designed to wreak havoc, Perspective • Leading cause of Morbidity and Mortality • Estimated at 780,000 deaths per year • Difficult diagnosis to make • In patients suspected of having the disease, approximate 10-20% are positive • Approximate 66% of PE cases are missed. Amina Adel Al-Qaysi • Conversely, 62% of patients on anticoagulation therapy for suspected PE and subsequently died, no PE was found on autopsy, DVT to PE • Diagnosis of DVT • 600,000 hospitalizations • Diagnosis is underestimated • Diagnosis of PE • 400,000 missed each year • Mortality if untreated is 20-30% • Mortality if treated is 2-10% • 100,000 potential lawsuits • Cardiac arrest (PEA): TEE demonstrated 36% prevalence rate for PE, Vichow’s Triad • Hypercoagulability • Endothelial damage • Stasis, Thromboembolism Risk Factors • Age > 40 (old age in Rosen’s) • History of venous thromboembolism • Surgery longer than 30 minutes • Prolonged immobilization (airplanes—ASA) • CHF • Cancer • Obesity • Pregnancy or recent delivery • Hormone replacement therapy • Hypercoagulable states, Thromboembolism Risk Factors • Hypercoagulable states • Factor V Leiden (Most common) • AT III deficiency • Protein C deficiency • Protein S deficiency • Prothrombin G20210A mutation • Anticardiolipin antibody syndrome • Lupus anticoagulant, DVT • Homans’ and pseudo-Homans’ • Pseudo-Homans’: tenderness when squeezing the calf • Homans’: Foot held in plantar flexation • Repudiated by Homan himself • Classic physical findings present • Only 50% have DVT • Plegmasia Dolens • White, painful, edematous, cold, and pulseless • Limb threat—call vascular—or amputation required • Approx. • Level B recommendation that a negative whole blood D-dimer assay in a low pre-test probability patient as assessed by the Wells criteria excludes PE or lower extremity DVT • There was insufficient evidence to make any Level B recommendations in regard to utilizing the whole blood qualitative D-dimer assay without Well's clinical scoring system. Reality: PEITHO 2014 (Pulmonary Embolism Thrombolysis) Single IV bolus of tenecteplase (thrombolytic agent) + heparin Vs. placebo + heparin. Download Pulmonary PowerPoint templates (ppt) and Google Slides themes to create awesome presentations. Pulmonary Embolism: Symptoms and Treatment - Step To Health. 8 Chronic treatment and prevention of recurrence. Flashcards. Define the clinical types of Pulmonary Embolus. venous thromboembolism (vte) in icu. They should be essential in everyday clinical decision making. Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, haemoptysis, syncope, hypotension, and shock. joel frankel, md, facp, fccp plantation general hospital, Post-Op Pulmonary Embolism - . Gravity. COVID-19 and Pulmonary Embolism: Frequently Asked Questions (Version 4.0; last updated December 24, 2020) Input from Agnes Lee, Maria deSancho, Menaka Pai, Menno Huisman, Stephan Moll, Walter Ageno, and Lisa Bauman-Kreuziger understand radiologic studies used to, Pulmonary Vascular Diseases - Pulmonary embolism. Because the clots block blood flow to the lungs, pulmonary embolism can be life-threatening. Am J Respir Crit Care Med 2005;172:1041-6. vasculature • Pain control • Morphine: pulmonary vasodilator • Shock: • Fluid Boluses • Volume expansion may not beneficial: actually will increase RV afterload and worsen RV function • Shock should be treated with norepinephrine (Rosen’s) • Fibrinolytics indicated: expected mortality decrease of 50%, Fibrinolysis • Fibrinolytics/Surgery in cardiopulmonary arrest • CPR has no benefit (36% of PEAs) • Emergency cardiopulmonary bypass (one study that showed 7 out of 9 patients survived) • Bilateral emergency thoracotomy and massage of the pulmonary vasculature • Patient with known PE in ED or in transfer to the ED has Arrest—give alteplase 100 mg bolus then CPR x 20 minutes • Fibrinolytics indicated in: • Cardiogenic shock • RV Failure either by ECHO or strain on EKG • Prior history of PE or known Protein C, Protein S, AT III deficiencies (emedicine) (patients with high likelihood for recurrences), Fibrinolysis • Indicated for iliofemoral DVT • Call intervential radiologist • Complications of fibrinolytics • ICH bleeding 2% • Bleeding 20% • “Fibrinolysis should be considered for all patients with PE who lack specific contraindications to the therapy. 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