Treating Pulmonary Embolism
Medgeeks with Andrew Reid
Medgeeks
4.8 • 997 Ratings
🗓️ 13 September 2018
⏱️ 10 minutes
🧾️ Download transcript
Summary
Last week we presented a patient presenting with signs and symptoms of a PE and CTA confirmed saddle pulmonary embolism.
So, now the questions is, what type of PE is this?
- Massive
- Submassive
- Non-massive (low risk)
It's important we separate patients into different categories, because each category will have different adverse outcomes, and more importantly, differences in mortality risk.
Therefore, if we can group these patients into a category, then this is the first step in identifying the best course of action.
Today, we'll walk you through this every step of the way!
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Transcript
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| 0:00.0 | Welcome back team. |
| 0:01.8 | Zach here for med geeks. So did you do your homework? How are we treating this |
| 0:06.9 | pulmonary embolism? Well, let's re-summerize the case first and we'll take it from |
| 0:11.9 | there. So you have a 62 year old female morbid |
| 0:15.1 | obesity with a BMI of 43 fell three weeks ago with a right tibia fracture requiring |
| 0:21.4 | a cast. She has been immobile, developed some shortness of breath |
| 0:25.2 | over the past two weeks, which is worsened to the point where she can't even put on clothes |
| 0:29.7 | without being symptomatic. She also has a right leg that's swollen and painful and it's only worsening. |
| 0:36.5 | Vitals reveal no fever. She's tachycardic to 118. Stable blood pressure of 132 over 84. She's on 3 liters nasal canula to keep |
| 0:46.3 | saturation above 96%. On exam she's awake to Kipnick with clear long sounds, labs reveal |
| 0:54.6 | Treponans elevated to 0.83, Pro B&P elevated to 8.50. |
| 1:00.4 | Echo reveals moderate RV dysfunction, lower extremity duplex ultrasound reveals a right lower extremity popletial dvt. |
| 1:09.0 | CTA shows saddle pulmonary embolism. |
| 1:12.0 | So now the question is what type of PE is this? Massive, submassive, or is it |
| 1:20.2 | non-massive aka aka low risk. |
| 1:23.0 | Also turned by the European Society guidelines as high risk, |
| 1:27.3 | intermediate risk, which is then broken down |
| 1:29.7 | into high and low intermediate risk subcategories and low risk respectively. |
| 1:35.0 | Well first why do we need to classify patients into different categories you may ask? |
| 1:42.0 | Well we know that patients among the three different categories have different |
| 1:46.2 | adverse outcomes and more importantly, differences in mortality risk. Therefore, if we can classify and group pulmonary embolism patients, this is one |
| 1:56.8 | step closer toward identifying the best course of management, whether that be systemic |
... |
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