Critical Care Case Studies

Critical Care Case Studies-22
Rotatable pigtail catheter [20]: The pigtail tip of this catheter (Cook Europe; Bjaeverskov, Denmark) is rotated either by hand or by an attachable low-speed electric catheter to disrupt the intrapulmonary clot into smaller fragments which then migrate into the distal pulmonary circulation.The catheter can be advanced into peripheral pulmonary branches and manually rotated to further clot fragmentation. FIGURE 1: CT scan of the chest demonstrating pulmonary emboli in bilateral main pulmonary artery What distinguishes massive from submassive pulmonary embolism?

Rotatable pigtail catheter [20]: The pigtail tip of this catheter (Cook Europe; Bjaeverskov, Denmark) is rotated either by hand or by an attachable low-speed electric catheter to disrupt the intrapulmonary clot into smaller fragments which then migrate into the distal pulmonary circulation.The catheter can be advanced into peripheral pulmonary branches and manually rotated to further clot fragmentation. FIGURE 1: CT scan of the chest demonstrating pulmonary emboli in bilateral main pulmonary artery What distinguishes massive from submassive pulmonary embolism?

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Historically, surgical embolectomy was the only available option for patients who fail or who have contraindications to systemic thrombolysis.

It is not clear what role it will play in the future given the advent of other interventional options (listed below).

She was brought to the emergency department, where vital signs were notable for temperature of 100.9ºF, HR=142/min, BP=90/60 mm Hg after intravenous fluids, with oxygen saturation of 99% while breathing 100% oxygen via non-rebreather mask.

Columbia University College of Physicians and Surgeons HISTORY:55-year-old female nursing home resident with past medical history of AIDS, dilated cardiomyopathy (estimated left ventricular ejection fraction 15% on a previous transthoracic echocardiogram), and prior deep venous thrombosis (DVT) was found to be hypotensive and in respiratory distress while at her skilled nursing facility.

Correct answer: E Doppler echocardiogram can be useful in supporting the diagnosis of submassive and massive pulmonary embolism, especially in the cases where a contrast chest CT cannot be performed immediately.

Findings on Doppler echocardiogram demonstrate acute right ventricular pressure overload Echocardiographic findings may also help to distinguish the chronicity of events in patients with massive pulmonary embolus, which may be of clinical relevance regarding therapy [3].

Small studies, including case series and controlled trials, have evaluated the efficacy of intrapulmonary thrombolysis [21-23].

Although clinical endpoints such as mortality were not evaluated, these studies suggest equivalent or superior radiographic resolution of thrombolysis compared to systemic thrombolysis.

The trachea was urgently intubated and heparin was discontinued.

Interventional radiology was consulted for catheter thrombectomy and inferior vena caval (IVC) filter placement.

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