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Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Pulmonary Embolism I: Introduction01:29

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Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
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A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
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Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
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Venous Thrombosis I: Introduction01:30

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Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
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SARS-CoV-2 and pulmonary embolism: who stole the platelets?

Michael Tran1, Chirag Sheth1, Rohan Bhandari1

  • 1Heart Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic Foundation, Desk J-35, Cleveland Clinic Foundation, Cleveland, OH 44195 USA.

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|September 9, 2020
PubMed
Summary

Patients with SARS-CoV-2 may develop thrombocytopenia due to heparin-induced thrombocytopenia (HIT). Early recognition and switching anticoagulation can resolve this serious complication.

Keywords:
COVID-19HITHeparinPulmonary embolismSARS-CoV-2Thrombosis

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Area of Science:

  • Hematology
  • Infectious Diseases
  • Immunology

Background:

  • SARS-CoV-2 infection is linked to increased risk of venous and arterial thrombosis.
  • Thrombotic events contribute significantly to patient mortality in COVID-19.
  • Immunological changes, including antiphospholipid antibodies and thrombocytopenia, are observed in SARS-CoV-2 patients.

Observation:

  • A patient with SARS-CoV-2 pneumonitis presented with intermediate risk pulmonary embolism.
  • Daily monitoring of platelet counts raised suspicion for immune-mediated heparin-induced thrombocytopenia (HIT).

Findings:

  • Immune-mediated heparin-induced thrombocytopenia (HIT) was confirmed through laboratory testing.
  • Thrombocytopenia resolved upon switching anticoagulation from heparinoids to a direct thrombin inhibitor.

Implications:

  • This case highlights the importance of considering unrecognized HIT in SARS-CoV-2 patients experiencing thrombocytopenia, especially those on heparinoids.
  • Further research should explore the central role of platelets in the pathogenesis of thrombosis during the COVID-19 pandemic.