acute massive pulmonary embolism
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acute massive pulmonary embolismA condition defined as “…obstruction or significant filling defect involving two or more lobar pulmonary arteries, or the equivalent amount of emboli in smaller or other arteries”. It is the second most common cause of sudden death, after sudden cardiac death.
Nonspecific; index of suspicion should be high in patients with dyspnea, tachypnea, or chest pain and risk factors for pulmonary embolism.
Pulmonary angiography is the gold-standard diagnostic modality, but is rarely performed, as CT angiography is nearly as sensitive and specific.
Immediate full anticoagulation followed by long-term anticoagulation, to prevent deep-vein thrombosis and recurrent pulmonary embolism.
Risk factors, pulmonary embolism
Surgery and trauma
Oral contraceptives and estrogen replacement
Hereditary factors resulting in a hypercoagulable state
Acute medical illness
Central venous instrumentation within the past 3 months
Chronic obstructive pulmonary disease
Drug abuse (intravenous drugs)
Drug-induced lupus anticoagulant
Inflammatory bowel disease
Malignancy, especially lung cancer
Prior pulmonary embolism
Stroke, paresis, or paralysis
Surgery within the last 3 months
Current or past history of thrombophlebitis
Travel of 4 hours or more in the past month
Trauma to the lower extremities and pelvis during the past 3 months
Warfarin (first few days of therapy)