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See also: Anticoagulants
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Controversies in Pulmonary Embolism and Deep Venous Thrombosis, American Family Physician:"The diagnosis of venous thromboembolic disease, and pulmonary embolism in particular, remains problematic. Physicians should strongly consider empiric anticoagulation if the best available diagnostic tests are inconclusive, because treatment is usually safe and successful. Twice-daily subcutaneous low-molecular-weight heparin, dosed without monitoring, may eventually replace standard heparin for most treatment of venous thromboembolism, but it is not yet labeled for the treatment of pulmonary embolism. Deep venous thrombosis and pulmonary embolism should be treated with anticoagulants rather than inferior vena cava filters, even in oncology patients, unless anticoagulation is contraindicated; if so, when the contraindication remits, anticoagulation should be employed." ******************************************************
Detection of Pulmonary Emboli Resulting from Ovarian Vein Thrombosis, American Journal of Roentgenology:"A 49-year-old woman was admitted to our hospital after having an MRI-confirmed infarct in the territory of the left middle cerebral artery. Results from a complete workup, including echocardiography, ECG monitoring, and Doppler sonography of the carotid artery, were all negative. The patient was treated conservatively, and her symptoms gradually improved. One week later, she developed acute chest tightness and dyspnea. An analysis of blood gases indicated hypoxemia, and a provisional diagnosis of pulmonary embolism was made. The findings of chest radiography were normal. Ventilation–perfusion scans revealed multiple left-sided peripheral defects and confirmed the diagnosis of pulmonary embolism with a classic pattern of ventilation–perfusion mismatch (Figs. 1A and 1B)." ******************************************************
What causes Pulmonary Embolus? Canadian Lung Association:"Pulmonary emboli are caused by clots from the venous circulation, from the right side of the heart, from tumors that have invaded the circulatory system, or from other sources such as amniotic fluid, air, fat, bone marrow, and foreign substances. Most are caused from clots originating in the lower extremities called deep vein thrombosis(DVT), and many resolve on their own. A pulmonary embolism affects as many as 5 out of 10,000 people in the U.S. each year, and sudden death can occur as a result of pulmonary embolism. The risk factors include prolonged bed rest or inactivity, oral contraceptive use, surgery, child birth, cancer, stroke, heart attack, heart surgery, and fractures of the hips or femur." ******************************************************
Pulmonary Emboli, Ecureme.com:"The arterial blood (oxygen-rich blood) supply to the lungs via the pulmonary artery or one of its branches can be blocked by matter such as a blood clot (most common), fat, air, tumor (abnormal growth) tissue, bone marrow, amniotic fluid (fluid in the womb), or foreign substances. This is called a pulmonary embolus (plural emboli)." ******************************************************
Pulmonary Embolism, Emedicine.com:"Pulmonary embolism (PE) is an extremely common and highly lethal disease that is a leading cause of death in all age groups. A good clinician will actively seek the diagnosis as soon as there is any suspicion whatsoever of PE, since prompt diagnosis and treatment can dramatically reduce the mortality and morbidity of the disease. Unfortunately, the diagnosis is missed far more often than it is made, because PE often causes only vague and nonspecific symptoms." ******************************************************
Pulmonary embolism, Causes and symptoms, HealthAtoZ.com:"Pulmonary embolism is caused by emboli that travel through the blood stream to the lungs and block a pulmonary artery. When this occurs, circulation and oxygenation of blood is compromised. The emboli are usually formed from blood clots but are occasionally comprised of air, fat, or tumor tissue. Risk factors include: prolonged bed rest, surgery, childbirth, heart attack, stroke, congestive heart failure, cancer, obesity, a broken hip or leg, oral contraceptives, sickle cell anemia, congenital coagulation disorders, chest trauma, certain congenital heart defects, and old age." ******************************************************
Noninvasive Diagnosis of Pulmonary Embolism, Hospital Practice:"With the development of new methods for detecting pulmonary embolism, the need for angiography has been greatly reduced. Plasma D-dimer assays, lower-limb ultrasonography, and ventilation/perfusion lung scans in combination with the clinical assessment enable safe, cost-effective diagnoses." ******************************************************
Pulmonary embolus, Causes, incidence, and risk factors, Medical Encyclopedia, Medline Plus:"Pulmonary emboli are blockages of the blood vessels of the lungs (pulmonary vessels). Most often they are caused by blood clots from the veins, especially veins in the legs or in the pelvis (hips). More rarely, air bubbles, fat droplets, amniotic fluid, or clumps of parasites or tumor cells may obstruct the pulmonary vessels.
The most common cause of a pulmonary embolism is a blood clot in the veins of the legs, called a deep vein thrombosis (DVT). Many vlear up on their own, though some may cause severe illness or even death.
Risk factors include the following:
Prolonged bed rest or inactivity (including long trips in planes, cars, or trains),
Oral contraceptive use
Surgery (especially pelvic surgery)
Childbirth
Massive trauma
Burns
Cancer
Stroke
Heart attack
Heart surgery
Fractures of the hips or femur" ******************************************************
Pulmonary Embolus, Etiology and Pathogenesis, The Merck Manual of Diagnosis and Therapy:"The most common type of pulmonary embolus is a thrombus that usually has migrated from a leg or pelvic vein. Most of those that cause serious hemodynamic disturbances form in an iliofemoral vein, either de novo or by propagation from calf vein thrombi. Thromboemboli originate infrequently in the arm veins or in the right cardiac chambers.
Once released into the venous circulation, thromboemboli are distributed to both lungs in about 65% of cases, to the right lung in 25%, and to the left lung in 10%. Lower lobes are involved four times more often than upper lobes. Most thromboemboli lodge in large or intermediate (elastic or muscular) pulmonary arteries; 35% or fewer reach the smaller arteries." ******************************************************
Early intervention in massive pulmonary embolism
A guide to diagnosis and triage for the critical first hour, Postgraduate Medicine:"In about 50% of patients with pulmonary embolism, the embolism is massive, that is, accompanied by at least one of several potentially compromising conditions. Unfortunately, about three fourths of patients who die of pulmonary embolism do so within 1 hour of symptom onset. Thus, expeditious assessment of patients with suspected massive pulmonary embolism is crucial. In this article, Dr Gossage discusses prompt recognition of this condition and presents several management strategies." ******************************************************
Diagnosis of Pulmonary Embolus, Virtual Hospital:"Introduction and Objectives
Clinical Presentation
Chest Radiography
Ventilation Perfusion
Computed Tomography
Pulmonary Angiography
Conclusion
Diagnostic Algorithm
Case Studies
Obesity and New Atrial Fibrillation
Non-specific Symptoms
No Apparent Risk Factors
Pneumonia
Substernal Chest Pain
Interstitial Lung Disease
Post-OP Atelectasis
Collagen Vascular Disease
Syncope
Abdominal and Back Pain
Renal Carcinoma
Head Injury
Multiple Myeloma
History of Previous Emboli
Motor Vehicle Injury
Confusion
Cardiomyopathy
Myasthenia Gravis
Stroke
Rheumatic Heart Disease
Oral Contraceptives
Chronic Obstructive Pulmonary Disease
Congestive Heart Failure
Paraplegia
Indwelling Venous Catheter
Weight Loss and Hemoptysis
Osteosarcoma and Back Pain
Diabetic with Fractured Ankle
Non-Small Cell Carcinoma
Automobile Trip." ****************************************************** ****************************************************** For Health Information you can use, Follow, Connect, Like us on (Most Invites Accepted): http://www.nursefriendly.com/social/: Twitter! http://www.nursefriendly.com/twitter Blogger: http://4nursing.blogspot.com Facebook: http://www.nursefriendly.com/facebook Linked In: http://www.linkedin.com/in/nursefriendly Nursing Entrepreneurs, Nurses In Business, http://nursingentrepreneurs.ning.com/ Posterous.com, http://nursefriendly.posterous.com StumbleUpon, http://www.nursefriendly.com/stumbleupon
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