肺栓塞的急诊评估和治疗(修).pptVIP

Approximately 10% of patients have peripheral occlusion of a pulmonary artery, causing parenchymal infarction. These patients present with acute onset of pleuritic chest pain, breathlessness, and hemoptysis. Although the chest pain may be clinically indistinguishable from ischemic myocardial pain, normal ECG findings and no response to nitroglycerin rules out myocardial pain. Patients with acute pulmonary infarction have decreased excursion of the involved hemithorax, palpable or audible pleural friction rub, and even localized tenderness. Signs of pleural effusion, such as dullness to percussion and diminished breath sounds, may be present. Differentials Acute Coronary Syndrome Acute Respiratory Distress Syndrome Anxiety Disorders Aortic Stenosis Atrial Fibrillation Atrial Fibrillation, Diagnosis and Management Cardiogenic Shock Cardiomyopathy, Dilated Cardiomyopathy, Restrictive Chronic Obstructive Pulmonary Disease Congestive Heart Failure and Pulmonary Edema Cor Pulmonale Emphysema Extrinsic Allergic Alveolitis Fat Embolism Lung, Arteriovenous Malformation Mitral Stenosis Myocardial Infarction Myocardial Ischemia Pericarditis and Cardiac Tamponade Pneumothorax Pulmonary Edema, Noncardiogenic Pulmonary Hypertension, Primary Pulmonary Hypertension, Secondary Sudden Cardiac Death Sudden Cardiac Death Superior Vena Cava Syndrome Syncope Clinical signs and symptoms for pulmonary embolism are nonspecific; therefore, patients suspected of having pulmonary embolism—because of unexplained dyspnea, tachypnea, or chest pain or the presence of risk factors for pulmonary embolism—must undergo diagnostic tests until the diagnosis is ascertained or eliminated or an alternative diagnosis is confirmed. Further, routine laboratory findings are nonspecific and are not helpful in pulmonary embolism. Pulmonary angiography remains the criterion standard for the diagnosis of pulmonary embolism, but with the improved sensitivity and specificity of CT angio