33
H hô h p
What is a PE?
This is occlusion of the pulmonary
vasculature by a clot. Often it
occurs from a deep vein thrombosis
(DVT) that has become dislodged
and forms an embolus that lodges
in the pulmonary arterial
vasculature, blocking the vessels.
Signs and symptoms
•
Breathlessness: this may be of
sudden onset or progressive.
•
Tachypnoea.
•
Pleuritic chest pain.
•
Cyanosis.
•
Haemoptysis.
Causes
•
DVT.
•
Air embolus.
•
Fat embolus.
•
Amniotic fluid embolus.
•
Foreign material introduced
via IV drug use.
Xét nghi m
•
D-dimer: nh y c m nhưng
không đ c hi u, âm tính không
th lo i tr PE.
•
Tăng đông máu: BN<50t
có thuyên t c ph i tái phát.
•
XQ l ng ng c: thư ng là
bình thương.
•
Đi n tim: nh p nhanh xoang
S1Q3T3 lo i c đi n
nhưng hi m; lo i tr nh i máu
cơ tim.
•
Khí máu ĐM: gi m oxy
máu.
•
CT, ch p ĐM ph i.
•
X hình ph i.
•
Dùng b ng đi m Well đ
tính toán nguy cơ c a PE.
Đi u tr
•
Đ t c p:
Oxy.
L p đư ng truy n TM
.
Thu c tiêu huy t kh i khi th y
bi u hi n...vd alteplase n u huy t kh i
nhi u ho c huy t đ ng không n đ nh.
.
Heparin tr ng lư ng phân t
th p.
•
Đi u tr lâu dài:
Kháng đông.
Lư i l c TM ch dư i.
Pathophysiology
The extent of thrombus may be classified
into small-medium, multiple and massive
PE. Symptom correlation depends on where
the pulmonary circulation is occluded.
There are 3 pathways involved in the
pathophysiology of PE:
1 Platelet factor release: serotonin
and thromboxane A
2
cause
vasoconstriction.
2 Decreased alveolar perfusion: lung is
underperfused and this leads to
diminished gas exchange.
3 Decreased surfactant: this leads to
ventilation/perfusion mismatch,
hypoxaemia and dyspnoea.
Bi n ch ng
•
Ch t đ t ng t.
•
RL nh p tim.
•
Nh i máu ph i.
•
Tràn d ch màng ph i.
•
Ngh n m ch ngh ch lí.
•
Tăng áp l c đ ng m ch
ph i.
MAP 2.8 Pulmonary Embolism (PE)
Sơ đ 2.8 T c ĐM ph i (PE)
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