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101-105 of 105 results with category "Vascular"
Beware older patients who present with lower extremity weakness and evidence of cauda equina syndrome. Patients with aortic occlusive syndromes (thrombosis) can look exactly like a spinal cord patient. Pearl: Always perform a good pulse check and examination of the skin (looking for skin mottling, i.e. livedo) in older patients who for all practicle purposes look like cord compression. The two conditions can lool a lot alike. And missing aortic occlusion may be fatal.
Elevation of Troponin I and BNP have been shown to be reliable serum markers of right ventricular dysfuncion in pulmonary embolism. Two pearls: 1. Don't forget PE in patients with chest pain and or dyspnea who have elevated troponins. 2. Elevation of serum BNP and Troponin in PE has been linked to worse outcomes. Get that ECHO early and consider lytics for PE patients who have elevated biomarkers.
The only FDA-approved thrombolytic drug for the treatment of pulmonary embolism is tPA. Current studies (including studies by Jeff Kline-"Dr. PE") are investigating the use of TNKase and other agents. For hemodynamically unstable PE (hypotension, RV dysfunction): tPA- give 100 mg over two hours as a drip (no bolus). Heparin must be stopped during infusion and restarted after the tPA has finished. More on serum markers of RV dysfunction next week...
Most common themes in medical malpractice cases involving missed aortic dissection: -Some combination of chest/back, chest/abdomen, or abdomen/back -Symptoms "above and below" the diaphragm (neck pain and abdominal pain, for e.g.) Sullivan, SullivanGroup.com 2006 Acute Aortic Disease, Elefteriades 2007
Update on the Wells Criteria for PE-patients with a score of 4 or less (which means low to moderate probability) can be considered for a "d-dimer negative" rule out approach. This is a bit of a change from the low risk only approach. Additionally, the British Thoracic Society guidelines support the low and moderate risk group patient rule out strategy. So, if you have a low or even moderate risk patient, you can use the approach of obtaining a highly sensitive d-dimer and if it is negative, the hunt for PE is over.