What Are the Parameters That Should Inform Gestalt as a Clinical Decision Strategy for Pulmonary Embolism?

The limitations of clinical decision rules1 are exemplified by the performance of the Wells criteria in primary care.2 The latter study enrolled 598 patients in whom the general practitioner considered that pulmonary embolism might be present. Suspicion of pulmonary embolism was based on the presence of 1 or more of the following symptoms: unexplained (sudden) dyspnea, deterioration in existing dyspnea, pleuritic pain, and unexplained cough. After recording the Wells score, the primary care doctor was required to refer the patient to secondary care for further evaluation.
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Letter Source Type: research

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Authors: Underner M, Peiffer G, Perriot J, Jaafari N Abstract Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine use and pulmonary complications. Cocaine can be responsible for acute respiratory symptoms (cough, black sputum, hemoptysis, dyspnea, wheezing, chest pain) and for various pulmonary disorders including barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium), airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alve...
Source: Revue des Maladies Respiratoires - Category: Respiratory Medicine Tags: Rev Mal Respir Source Type: research
Pulmonary thromboembolism (PE) causes high morbidity and mortality. Due to limited information about the disease in our country, information from others must often be used. That is why we conducted a prospective observational study on the epidemiology of PE treated in a high complexity hospital from Colombia.A search of the scientific literature was carried out finding several initiatives and only two previous local ones. A review of the risk factors, clinical presentation, diagnostic process, treatment, complications and prognosis of the disease was used to construct the tool for data collection in the RedCap program. Bet...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Pulmonary embolism Source Type: research
We present our 4 years experience on this subject. SUBJECTS AND METHODS: We retrospectively studied 2178 lung perfusion scintigraphies (LPS). Of them 1846 were performed to patients suspected for APE admitted to the emergency departments of the University Polyclinic of Bari and examined immediately by our Nuclear Medicine Department. Contingency tables and odds ratio (OR) were used to estimate the relation between symptoms, risk factors, D-dimers dosage, other imaging diagnostic tools and LPS results. RESULTS: Lung perfusion scintigraphy was positive for APE in 309/1846 (16.7%) patients which then were treated succ...
Source: Hellenic Journal of Nuclear Medicine - Category: Nuclear Medicine Tags: Hell J Nucl Med Source Type: research
Authors: James J, Thulaseedharan NK, Jayachandran NV, Geetha P Abstract Lemierres syndrome (LS) refers to suppurative thrombophlebitis of internal jugular vein (IJV) secondary to oropharyngeal infection. It is caused by the anaerobic bacteria Fusobacterium necrophorum. Here we report a case of LS secondary to retropharyngeal abscess in a pregnant lady with possible underlying connective tissue disorder. A 19-year old primigravida at 6-weeks of gestation, presented with fever, cough, dyspnea, right sided neck pain and swelling. Imaging showed right lower lobe pneumonia with bilateral pulmonary infiltrates and pleura...
Source: Journal of the Association of Physicians of India - Category: General Medicine Tags: J Assoc Physicians India Source Type: research
Discussion Pulmonary embolism (PE) is potentially life-threatening but fortunately rare event especially in the pediatric population. It was first described in children in 1861. PE is likely underreported because of minimal or non-specific clinical symptoms. The incidence is estimated at 0.05-4.2% with the 4.2% based on autopsy reports. It is probably also increasing as more central venous catheters (CVC) are used, and more children are surviving previously poor prognostic diseases. There is a bimodal distribution with cases
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
A 40-something male with no PMH of any kind presented  to urgent care on a weekend (cath team is at home) with cough starting 2 weeks prior and SOB one week prior.He underwent a chest x-ray:As this was consistent with " pulmonary edema vs. viral infection, " and he was transferred to the EDThe faculty physician did an immediate cardiac and lung ultrasound:Many B lines (probable pulmonary edema)Parasternal short axis cardiac ultrasound:The anterior wall is closest to the transducer and shows an obvious wall motion abnormalityFurther history:The patient denied chest pain but stated that he had had ab...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Authors: Mian A, Singal AK, Bakhshi S, Sood R, Vikram NK, Ray A Abstract A 21-year old female, recently diagnosed with osteosarcoma of right humerus, presented to the emergency with history of fever, productive cough, chest pain and progressive respiratory distress for six days. Initial investigations suggested pneumonia but she did not respond to parenteral antibiotics. CT pulmonary angiogram revealed bilateral pulmonary artery embolism. Thrombolysis was performed using alteplase, which failed to improve the clinical condition. In view of underlying malignancy, a possibility of tumour-embolism was considered and s...
Source: Journal of the Association of Physicians of India - Category: General Medicine Tags: J Assoc Physicians India Source Type: research
Publication date: Available online 13 April 2019Source: Revista Clínica Española (English Edition)Author(s): L.C. García Gómez, L. Castilla Guerra, M. Gandullo Moro, R. Cano Alba, M. Paniagua García, M.Á. Colmenero CamachoAbstractBackgroundDiagnosing pulmonary embolisms can be challenging, given that its presentation shares clinical manifestations with other conditions. For patients 80 years of age or older, the healthcare challenge increases due to associated comorbidity when compared with younger patients (
Source: Revista Clinica Espanola - Category: Internal Medicine Source Type: research
Obstructive lesions to the pulmonary circulation present with nonspecific symptoms varying from chest pain, dyspnea on exertion, and cough to florid right heart failure.1 Congenital pulmonic stenosis, pulmonary embolism (PE), and chronic thromboembolic pulmonary hypertension (CTEPH) are common etiologies.2 Primary tumors of the pulmonary vasculature are less common and more likely occur owing to metastatic involvement.3 Given the rarity of these tumors, their presentation commonly is misdiagnosed, and patients commonly are treated for chronic thromboembolism.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: E-Challenge Source Type: research
A 49-year-old woman presented to the Emergency Department with nonmassive hemoptysis. She also complained of a 2-day history of generalized weakness, shortness of breath, pleuritic chest pain, and productive cough. She reported a previous history of liver hydatid disease that was being treated with albendazole. Upon admission, vital signs were as follows: blood pressure 135/85  mm Hg, respiratory rate 24 breaths/min, pulse rate 118 beats/min, and SpO2 89% in room air. Bloody stained sputum and a low-grade fever were also noted.
Source: The Journal of Emergency Medicine - Category: Emergency Medicine Authors: Tags: Visual Diagnosis in Emergency Medicine Source Type: research
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