| Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. | |
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MedLine Citation:
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PMID: 11888976 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Major pulmonary embolism (PE) results whenever the combination of embolism size and underlying cardiopulmonary status interact to produce hemodynamic instability. Physical findings and standard data crudely estimate the severity of the embolic event in patients without prior cardiopulmonary disease (CPD) but are unreliable indicators in patients with prior CPD. In either case, the presence of shock defines a threefold to sevenfold increase in mortality, with a majority of deaths occurring within 1 h of presentation. A rapid integration of historical information and physical findings with readily available laboratory data and a structured physiologic approach to diagnosis and resuscitation are necessary for optimal therapeutics in this "golden hour." Echocardiography is ideal because it is transportable, and is capable of differentiating shock states and recognizing the characteristic features of PE. Spiral CT scanning is evolving to replace angiography as a confirmatory study in this population. Thrombolytic therapy is acknowledged as the treatment of choice, with embolectomy reserved for those in whom thrombolysis is contraindicated. |
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Authors:
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Kenneth E Wood |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Chest Volume: 121 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 2002 Mar |
Date Detail:
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Created Date: 2002-03-12 Completed Date: 2002-04-09 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: 877-905 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, University of Wisconsin Hospitals & Clinics, Madison, WI 53792, USA. kew@medicine.wisc.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Blood Gas Analysis Electrocardiography Heart Arrest / complications, physiopathology Heart Failure / physiopathology Hemodynamics Humans Models, Biological Pulmonary Embolism / diagnosis, drug therapy, physiopathology*, surgery Pulmonary Gas Exchange Pulmonary Veno-Occlusive Disease / physiopathology Shock / physiopathology Stroke Volume Thrombectomy Thrombolytic Therapy Ventricular Dysfunction / physiopathology |
| Comments/Corrections | |
Comment In:
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Chest. 2002 Dec;122(6):2264; author reply 2264-5
[PMID:
12475878
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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