Management of pulmonary embolism patients in the emergency department setting

master's thesis

• Title (croatian): Obrada i liječenje bolesnika s plućnom embolijom u odjelu hitne medicine
• Author: Kim André Brevik
• Mentor: Vesna Degoricija (mentor)
• Committee member: Vesna Degoricija (predsjednik povjerenstva)
• Committee member: Ivan Gornik (član povjerenstva)
• Committee member: Radovan Radonić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2019-09-10, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Emergency Medicine

Abstract

Pulmonary embolism (PE) is a potential fatal disorder. It is the blockage of one of the pulmonary arteries in the lungs. In most cases, blood clots are the reason for the block and often, more than one clot is involved in causing the block. The clot often originates from the deep veins of the lower limbs, a condition known as deep venous thrombosis (DVT). The most common clinical manifestations in PE includes sudden onset dyspnea, tachypnea, pleuritic chest pain, cough and hemoptysis. Clinical findings that should raise the suspicion to PE are, lower leg pain or swelling, pleuritic chest pain, dyspnea and elevated D-dimers on blood tests (although not very specific for the disease, but a negative D-dimer would virtually exclude PE as a likely diagnosis). The challenge for the doctors working in the emergency room, can be to recognize the clinical presentation of a PE, as the symptoms often are non-specific. Unrecognized PE can potentially have fatal effects for the patient. The treatment is aimed at keeping the clot from becoming bigger and prevention of new clot formation. The mainstay of treatment of PE is anticoagulation whereas the most commonly used are heparin subcutaneous or intravenous, oral anticoagulants (warfarin) and
new oral anticoagulants (NOAC). This is why recognition, combined assessment and intervention is of utter importance for the overall outcome.

Abstract (croatian)

Plućna embolija (PE) je potencijalno smrtonosna bolest uzrokovan blokadom protoka kroz jednu ili više plućnih arterija. U većini slučajeva PE ugrušak dolazi iz dubokih vena nogu, odnosno posljedica je duboke venske tromboze (DVT).
Najčešće manifestacije PE jesu: dispneja, tahipneja, pleuralna bol, kašalj i hemoptiza. Klinički nalazi koju podupiru sumnju na PE su oticanje ili bol u nogama, pleuralna bol, dispneja i povišeni D-dimeri u krvi (iako nespecifični, negativni D-dimeri isključuju PE kao moguću dijagnozu). Često nespecifični simptomi pri prvoj prezentaciji bolesnika s PE izazov su za liječnike u hitnoj službi. Neprepoznata PE potencijalno je fatalna za bolesnika. Cilj liječenja je prevencija povećanja ugruška i prevencija formiranja novih ugrušaka. Osnova za liječenje PE je antikoagulantna terapija. Najčešće se koriste supkutani ili intravenski heparin, oralni antikoagulansi poput varfarina ili novi oralni antikoagulansi (eng. new oral anticoagulants - NOAC). Pravovremeno prepoznavanje, kombinirana procjena i timsko liječenje od ključnog su značenja za ukupan ishod bolesti.

• Keywords: pulmonary embolism; anticoagulation; venous thrombosis
• Keywords (croatian): plućna embolija; antikoagulansi; venska tromboza
• Language: english
• URN:NBN: urn:nbn:hr:105:005388
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-07-20 08:02:52