Talk:Pulmonary embolism
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From "Treatment": "In PE, INRs between 2.5 and 3.5 are considered ideal." It's really that simple, is it? :) Gonegonegone 21:30, 5 Dec 2004 (UTC)
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- My impression was was that depending on the circs surrounding the PE (first, later, on or off warfarin at the time, what [if known!] is the background condition, and so on) it might well vary, so it would be hard to say "In PE" as if there was one universal standard ideal for all PEs. OK so I am not a medic, but a mere patient - but my own experience has been that of going from 3.0-4.5 to 3.0-4.0 to 2.5-3.5 as varying risk factors have been looked at, i.e. I have bled less or more. I wasn't sure that it was not a bit too simple to say "are considered ideal" so straightforwardly. But you may know otherwise, what with having all those letters after your name <g>, so please edit or leave as you see fit. I'm hoping to get more uninvolved from WP anyway so I will probably be quite happy with whatever you do! :) Gonegonegone 23:33, 5 Dec 2004 (UTC)
- You may be right. I'm gonna look into it. Please do not get uninvolved... Wikipedia needs you! :-) JFW | T@lk 08:22, 6 Dec 2004 (UTC)
Contents |
[edit] Traumatic PE
Gronky (talk • contribs) linked to a case series of 44 detainees of the US army, one of whom had reportedly died of PE after blunt force injury[1]. I'm really not sure what the point is here (apart from making the army look bad), but of the millions of people suffering PEs annually, very few have this as a result of injury. In fact, the textbooks only mention PE after trauma if there has been immobilisation or fat embolism from fractures of the long bones (or air embolism from jugular vein tears). I dispute the need of including this one case just to make a point. JFW | T@lk 23:47, 27 October 2005 (UTC)
- Hi Jfdwolff (talk • contribs). The article I linked to gives a medical description of how a pulmonary embolism occurred and caused death. Will you revert if it's re-added without mentioning that the US Army was involved? I thought the context was useful, but it's not the point. This particular case is interesting because its cause is not otherwise mentioned in the articled: a person getting a severe beating. It will be hard to find an example of such a case that doesn't make someone look bad. I think more examples would be useful, but I only happened across one. Gronky 00:24, 28 October 2005 (UTC)
- Actually, I don't have the energy. I probably won't come back to this for a few weeks. Maybe a section on "Available medical records of deaths by PE" would be better. Or whatever you think is best. Gronky 00:38, 28 October 2005 (UTC)
The cause and mechanism of death in PE is thoroughly understood, and needs little outside support. The link you've provided describes an oddity that has not caused much furore in the medical literature. What should the aim of the link be? JFW | T@lk 02:05, 28 October 2005 (UTC)
- I reviewed the pathology report full PDF. The examiner does not propose the mechanism of the PE, and I'd say the causality is somewhat doubtful. It seems to suggest that if you kick someone enough, they get blood clots in the lung - how? JFW | T@lk 02:22, 28 October 2005 (UTC)
[edit] Wells score
The Wells score is by far the most popular scoring system, especially when the D-dimer is being used. Reference: Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED d-dimer. Thromb Haemost 2000;83:416-20.
- Suspected DVT 3.0
- Alternative diagnosis less likely than PE 3.0
- HR >100 beats per minute 1.5
- Immobilization or surgery in the previous four weeks 1.5
- Previous DVT or PE 1.5
- Hemoptysis 1.0
- Malignancy (treatment, treated in the past six months or palliative) 1.0
- Interpretation: <2 points low, 2 to 6 points moderate, >6 points high
Good idea? JFW | T@lk 18:38, 31 July 2006 (UTC)
I think that reference 6 referes to DVT and not specifically PE, small point but there you go! Dcs26 12:24, 12 December 2006 (UTC)
[edit] Curious
No mention of putting a filter into the veinous return into the heart as a treatment? That's what happened to "a friend of mine".. (within a couple of hours of being resuscitated from multiple PEs on both lungs, including PEs on both main pulmonary arteries). This was in a cost-conscious UK NHS hospital after CT and then ultrasounding the source clots. They seem to be fairly common: the surgeon said he had put in about fifty, although if they can they wait for the TPA to clear out of the system before the intervention. --BozMo talk 08:33, 19 February 2007 (UTC)
- Interesting point, and we should probably cover inferior vena cava filters in this article. There is not a great deal of evidence for the use of filters in those with emboli from leg DVTs; standard anticoagulation treatment is not inferior to filters, and the filters themselves can generate thrombi, dislodge, get infected and heaven knows what else. They are useful for those who make emboli despite high-dose (INR 3.0-4.0) warfarin or those who have a contraindication to anticoagulation (e.g. previous haemorrhagic CVA). JFW | T@lk 10:45, 25 February 2007 (UTC)
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- Thanks for the correct article name, I hadn't see it. Actually with me it was an emergency measure. I had emboli on both lungs and was still shedding clots off the left knee, despite TPA and heparin. They thought one more clot on the lungs would probably be one too many. The consenting consultant did point out the lack of evidence base, of course. All UK NHS so they are pretty cost conscientious and don't go for unnecessary interventions. The filter is designed to come out within 15 days but the annual failure rate is about 3% (so not too bad although given I am 41 it is pretty certain to fail eventually) --BozMo talk 11:45, 25 February 2007 (UTC)
[edit] Risk stratification
There's much talk in the literature on risk stratification. With RV dysfunction as a negative prognostic indicator, some studies use cardiac biomarkers (troponin I and BNP) to stratify. We should probably cover this; I personally feel that no person with a confirmed (or highly suspected) PE should leave hospital without an echocardiogram. JFW | T@lk 10:48, 25 February 2007 (UTC)
