کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
5650933 | 1588080 | 2017 | 12 صفحه PDF | دانلود رایگان |
عنوان انگلیسی مقاله ISI
Circulatory collapse, right ventricular dilatation, and alveolar dead space: A triad for the rapid diagnosis of massive pulmonary embolism
ترجمه فارسی عنوان
سقوط خونریزی، انقباض بطن راست و فضای مرده آلوئولار: سه گانه برای تشخیص سریع آمبولیسم عظیم ریه
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موضوعات مرتبط
علوم پزشکی و سلامت
پزشکی و دندانپزشکی
طب اورژانس
چکیده انگلیسی
A triad of circulatory collapse, right ventricular dilatation, and large alveolar dead space is proposed for the rapid diagnosis and treatment of massive pulmonary embolism. A 17Â year-old female on oral contraceptives collapsed at home becoming incoherent with shallow breathing. Paramedics initiated mechanical chest compression and transported the patient to our emergency department, arriving minimally responsive with undetectable blood pressure but having positive corneal reflexes and bradycardia with wide QRS. The trachea was intubated and goal-directed echocardiography revealed marked right ventricular dilatation with septal flattening. The arterial PCO2 was 40Â mmHg with an end-tidal PCO2 of 8Â mmHg, revealing a large alveolar dead space. Persistent hypotension, bradycardia, and fading alertness despite epinephrine and norepinephrine infusions prompted resumption of chest compression. Intravenous alteplase (10Â mg bolus over 10Â min followed by 90Â mg over 110Â min) begun 125Â min after collapse improved hemodynamic function within 10Â min allowing discontinuation of chest compression. Five and a half hours after starting alteplase, the patient was hemodynamically stable and had normal end-tidal PCO2. A CT-angiogram showed the pulmonary arteries free of emboli but a thrombus in the right common iliac vein. The patient recovered fully and was discharged home on warfarin 8Â days later. Based on this and other reports, we propose a triad of circulatory collapse, right ventricular dilatation, and large alveolar dead space for the rapid diagnosis and treatment of massive pulmonary embolism, with systemic fibrinolysis as the first-line intervention.
ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: The American Journal of Emergency Medicine - Volume 35, Issue 6, June 2017, Pages 936.e1-936.e4
Journal: The American Journal of Emergency Medicine - Volume 35, Issue 6, June 2017, Pages 936.e1-936.e4
نویسندگان
Raúl J. Gazmuri, Dimple J. Patel, Rom Stevens, Shani Smith,