在患有肺栓塞的患者中昏迷
JAMA
|December 5, 1977
概括
昏迷是13%急性肺栓塞 (PE) 病例中的一个关键症状. 早期诊断PE需要寻找超越短暂低血压的额外线索,利用诸如动脉血液气体分析和肺部扫描等测试.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 紧急医疗 紧急医疗
背景情况:
- 昏迷作为急性肺栓塞 (PE) 的表现症状往往被忽视.
- 大规模的PE可能会导致暂时的低血压,导致错误地将昏迷归因于其他原因.
- 精确诊断PE需要仔细考虑临床表现和诊断测试.
研究的目的:
- 调查急性肺栓塞 (PE) 中昏作为主要症状的频率.
- 要突出与PE呈现为昏迷相关的诊断挑战.
- 强调在怀疑PE时寻找进一步的诊断线索的重要性.
主要方法:
- 对132个连续急性肺栓塞 (PE) 病例的回顾性审查.
- 通过肺血管造影证实了PE的文档.
- 对临床特征的分析,重点关注昏迷的发生率.
主要成果:
- 在经过审查的PE病例中,17例 (13%) 中,昏迷是最初或主要的临床特征.
- 在PE之后的过渡性低血压可能会自发消失,使诊断复杂化.
- 在非住院患者中,PE的诊断经常被错过,患者出现昏迷.
结论:
- 昏迷可能是急性肺栓塞 (PE) 的一个显著的症状.
- 在昏迷的患者中,应考虑对PE进行诊断评估,特别是如果存在其他暗示性线索.
- 动脉血液气体测定和肺部扫描是诊断PE的宝贵工具,当昏迷是突出的特征时.
相关概念视频
Measurement of Blood Pressure
Assessing blood pressure is a standard procedure executed in virtually all medical environments. The method utilized today was established over a hundred years ago by an innovative Russian doctor, Dr. Nikolai Korotkoff. The soft ticking noise, known as Korotkoff sounds, heard while taking blood pressure readings results from turbulent blood flow within the vessels. The apparatus required for this procedure includes a sphygmomanometer, a blood pressure cuff attached to a gauge, and a stethoscope.
Heart Failure III: Clinical Manifestations
Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
Pulmonary Embolism I: Introduction
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...
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
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...
Pulmonary Embolism III: Nursing Management
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...
Pulmonary Embolism I: Introduction
A blood clot, or thrombus, is a semi-solid mass composed of fibrin, platelets, and red blood cells. When it forms within a vessel, it can obstruct blood flow, known as thrombosis. If part of the clot detaches, it becomes an embolus that can travel and block distant vessels. When this occurs in the pulmonary arteries, it causes a condition known as pulmonary embolism (PE).Origin and ImpactMost often, the embolus originates from a thrombus in the deep veins of the lower limbs, a condition called...


