Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism

This study aimed to evaluate a pregnancy-adapted version of the YEARS algorithm for the management of suspected pulmonary embolism during pregnancy.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

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​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; &AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regio...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Postpartum hemorrhage (PPH), thrombosis and pulmonary embolism remain the leading causes of maternal morbidity and mortality across the world.1 In contrast, amniotic fluid embolism (AFE) is a rare clinical entity (1.7-6.6 per 100,000 maternities) characterized by difficulty of diagnosis and quick and often catastrophic changes in hemodynamics (cardiovascular collapse), respiration (respiratory failure) and hemostasis (disseminated intravascular coagulation (DIC) and consumptive coagulopathy). Cases of AFE are associated with a high case-fatality rates of 25 to 50%.
Source: International Journal of Obstetric Anesthesia - Category: Anesthesiology Authors: Tags: Editorial Source Type: research
Publication date: Available online 26 February 2019Source: Journal of Cardiology CasesAuthor(s): Toru Miyoshi, Hideo Kawakami, Reiko Hori, Kazuo Nakanishi, Takehisa Kusumoto, Yusuke Kono, Shinsuke Kido, Akira Oshita, Hiroshi MatsuokaAbstractA 39-year-old woman developed a pulmonary embolism at 28 weeks of gestation, after a 4-week period of bedrest, and required emergencycesarean section due to a decrease in fetal heart rate. Pulseless electrical activity (PEA) developed after intravenous anesthesia. The fetus was delivered 5 min after PEA onset, during cardiopulmonary resuscitation of the mother. Intravenous...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
AbstractPurpose of reviewThis manuscript addresses the risks for venous thromboembolism (VTE) during pregnancy and the associated challenges of both diagnosis and treatment.Recent findingsThe obstacles to diagnosis given lack of specificity of typical biomarkers to predict VTE in pregnancy, as well as the unique fetal and bleeding risks introduced by managing massive pulmonary embolism (PE) with thrombolytics or thrombectomy are highlighted.SummaryVTE during pregnancy and the postpartum window occurs at a 6 –10-fold higher rate compared with age-matched peers and is a major cause of morbidity and mortality. Hypercoag...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
Authors: Niwa K Abstract The number of women with congenital heart disease (CHD) at risk of pregnancy is growing because over 90% of them are grown-up into adulthood. The outcome of pregnancy and delivery is favorable in most of them provided that functional class and systemic ventricular function are good. Women with CHD such as pulmonary hypertension (Eisenmenger syndrome), severe left ventricular outflow stenosis, cyanotic CHD, aortopathy, Fontan procedure and systemic right ventricle (complete transposition of the great arteries [TGA] after atrial switch, congenitally corrected TGA) carry a high-risk. Most freq...
Source: Korean Circulation Journal - Category: Cardiology Tags: Korean Circ J Source Type: research
(Abstracted from J Clin Anesth, 33:346–350, 2016) It has been estimated that venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, occurs in 17 cases per 100,000 patients in the general population every year. Age (especially age>70 years), comorbid conditions (malignancy, history of VTE, pregnancy, and congestive heart failure), reduced mobility, and recent surgery or trauma increase the risk of VTE.
Source: Survey of Anesthesiology - Category: Anesthesiology Tags: Pharmacology Source Type: research
(Abstracted from Anesth Analg, 123(4):942–949, 2016) According to the World Health Organization, 14.9% of maternal deaths in developed nations such as those of Europe and North America, Australia, New Zealand, and Japan are thought to involve embolism. In the United States alone, per the Centers for Disease Control and Prevention (2006–2010), approximately 9.3% of pregnancy-related deaths are a result of thrombotic pulmonary embolism.
Source: Survey of Anesthesiology - Category: Anesthesiology Tags: Obstetric Anesthesia Source Type: research
ANESTHESIOLOGISTS with a practice in obstetrics must be acutely aware of the differential diagnosis of maternal cardiovascular collapse during pregnancy. The overall risk of maternal death is 6.5 in 100,000 deliveries and typically occurs in the third trimester.1 Deaths in the first and second trimesters are rare. The most common etiologies include pre-eclampsia (16%), amniotic fluid embolism (AFE) (14%), hemorrhage (12%), cardiac disease (11%), and pulmonary thromboembolism (9%). Less common etiologies include infection, medication error, and ectopic pregnancy.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Source Type: research
Publication date: Available online 5 July 2016 Source:Anaesthesia Critical Care & Pain Medicine Author(s): Anne-Sophie Ducloy-Bouthors, Max Gonzalez-Estevez, Benjamin Constans, Alexandre Turbelin, Catherine Barre-Drouard Points essentiels Any dyspnoea, chest pain, syncope or collapsus must alert women health care providers to engage rapidly the diagnosis process and emergent treatment of the cardio-circulatory failure. The larger competence of the obstetric anaesthetists to perform echographic diagnosis at the parturient bedside helps to a more rapid management than previously. Symptomatic and etiologic treatmen...
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
This study found that though it is often associated with coronary artery disease (CAD), it can also occur in those without significant CAD. It was not specifically associated with disease of right coronary artery disease. This cardioinhibitory response may be a manifestation of the Bezold-Jarisch reflex. Bezold-Jarisch reflex inhibits sympathetic activity (sympathetic withdrawal) and increases parasympathetic activity, resulting in bradycardia, which may be associated with vasodilatation, nausea and hypotension. Bezold-Jarisch has been described in the setting of inferior wall infarction and coronary angiography. Origin...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ Cardiology X-ray Featured Source Type: blogs
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