肺栓塞的急诊评估和治疗.ppt

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肺栓塞的急诊评估和治疗.ppt

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DifferentialsAcuteCoronarySyndromeAcuteRespiratoryDistressSyndromeAnxietyDisordersAorticStenosisAtrialFibrillationAtrialFibrillation,DiagnosisandManagementCardiogenicShockCardiomyopathy,DilatedCardiomyopathy,RestrictiveChronicObstructivePulmonaryDiseaseCongestiveHeartFailureandPulmonaryEdemaCorPulmonaleEmphysemaExtrinsicAllergicAlveolitisFatEmbolismLung,ArteriovenousMalformationMitralStenosisMyocardialInfarctionMyocardialIschemiaPericarditisandCardiacTamponadePneumothoraxPulmonaryEdema,NoncardiogenicPulmonaryHypertension,PrimaryPulmonaryHypertension,SecondarySuddenCardiacDeathSuddenCardiacDeathSuperiorVenaCavaSyndromeSyncopeClinicalsignsandsymptomsforpulmonaryembolismarenonspecific;therefore,patientssuspectedofhavingpulmonaryembolism—becauseofunexplaineddyspnea,tachypnea,orchestpainorthepresenceofriskfactorsforpulmonaryembolism—mustundergodiagnostictestsuntilthediagnosisisascertainedoreliminatedoranalternativediagnosisisconfirmed.Further,routinelaboratoryfindingsarenonspecificandarenothelpfulinpulmonaryembolism.Pulmonaryangiographyremainsthecriterionstandardforthediagnosisofpulmonaryembolism,butwiththeimprovedsensitivityandspecificityofCTangiography,itisnowrarelyperformed.theWellsruleperformsbetterinyoungerpatientswithoutcomorbiditiesorahistoryofvenousthromboembolismReprintedfromAmJMed,Vol.113,ChagnonI,BounameauxH,AujeskyD,etal,Comparisonoftwoclinicalpredictionrulesandimplicitassessmentamongpatientswithsuspectedpulmonaryembolism,pp269-75,Copyright2002.TheGenevacriteria,whichdependonlyonobjectivemeasures,leadtoastratificationwithapulmonaryembolismprevalenceof8%inthelowest-riskgroup(Genevascoreof0)—aprevalencetoohightobeneglectedTheperformanceofthisscoringsystemappearsequivalenttotha